TOTAL JOINT PAIN CONTROL PROTOCOL

(multi-modal pain management involves taking medications together that target different pain receptors)

BASELINE PAIN MEDS (take these around the clock)

1. 1. Tylenol (acetaminophen) 1000mg by mouth every 6 hours
   2. (if not diabetic) Decadron (dexamethasone) 4mg by mouth twice daily starting the evening of surgery (for 14 days ONLY)
   3. NSAID (Non-Steroidal Anti-Inflammatory Drug)  CHOOSE ONE (take with food for 6 weeks):

1. 1. 1. Advil/Motrin (ibuprofen) 600mg by mouth every 6 hours
      2. Aleve (naproxen) 440mg by mouth twice daily
      3. Celebrex (celecoxib) 200mg by mouth twice daily
      4. Mobic (meloxicam) 7.5mg by mouth twice daily
      5. Voltaren (diclofenac) 75mg by mouth twice daily

(if prescribed) Lyrica (Pregabalin) 75mg by mouth twice daily (nerve pain med)

BREAKTHROUGH NARCOTIC PAIN MEDS (take these every 4-6hours only as needed)

1. Tramadol 50mg 1-2 tabs by mouth every 4-6 hours as needed for pain (no refills after 6 wks postop)
2. Oxycodone (same narcotic in Percocet) 5mg ½ – 4 tabs by mouth every 4-6 hours as needed for pain (no refills after 6 wks postop)

OTHER MEDS

1. Tranexamic Acid (TXA) 650mg 2 tabs by mouth daily starting the evening of surgery (for 14 days ONLY) (decreases bleeding)
2. Aspirin 81mg by mouth twice daily starting the morning after surgery for 30 days (TO PREVENT BLOOD CLOTS (DEEP VENOUS THROMBOSIS (DVT))
3. (optional – not available via prescription) Diosmin 1 tab by mouth twice daily for 2 months (for leg swelling/edema)

WEANING/STOPPING INSTRUCTIONS: STOP NARCOTICS IF PAIN DOES NOT REQUIRE THEM OR IF YOU EXPERIENCE SIDE EFFECTS (NAUSEA/VOMITING/CONSTIPATION/FEELING ‘LOOPY’)

ORDER OF DISCONTINUATION: STOP OXYCODONE FIRST, TRAMADOL SECOND, TYLENOL THIRD.  CONTINUE NSAID IF POSSIBLE FOR 6 WEEKS POSTOP.

 

DO NOT FORGET TO TAKE YOUR ASPIRIN 81mg BY MOUTH TWICE DAILY FOR 30 DAYS POSTOP TO PREVENT BLOOD CLOTS (DEEP VENOUS THROMBOSIS (DVT) starting the morning after surgery.  Sometimes Eliquis 2.5mg by mouth twice daily for 6 weeks is used instead of Aspirin for high risk patients.