We asked 3 nurse anesthetists to share their pain management recipes during each stage of surgery for 3 notoriously painful procedures: total knees, shoulders and total hips. There was one condition: no opioids.
Mr. Schneider explains:
Pre-op: Give the patient oral Tylenol, clonidine and gabapentin, and administer an ultrasound guided adductor canal peripheral nerve block with catheter using 15-20 cc of 0.5% ropivacaine and 4 mg decadron. The patient can still extend his leg and walk with an adductor canal nerve block so we can get him ambulating sooner.
Intra-op: Spinal anesthetic for this case is preferred. Administer the ketamine, magnesium, and lidocaine infusion together to help with surgical pain during and after the procedure for a narcotic sparing technique.
Post-op: Overall goal for pain management is to provide superior analgesia without the need for narcotics. An adductor canal nerve block catheter will keep them pain free for 3 days using a 0.2% ropivacaine infusion at 10-14 mL/hr. Depending on the patient's risk factors, schedule gabapentin or Tylenol 3 times a day for post-op pain management. You can give 15-30 mg Toradol for any break through pain. We can do a 2-hour knee replacement with no opioids using this method.
