PostOp Analgesia for TKR

 This example applies to an otherwise healthy 70 yo patient:

• Femoral  catheter (inserted preop) bolus dose 20 mls 0.75% ropivacaine at
  end of surgery, then continuous infusion of 0.2 % ropivacaine at 8–12 mls/hr, usually start at 10 mls/hr.
• Paracetamol  1 GM PO/IV 6/24 strict for 3-4 days following Then PRN 6/24.
• Parecoxib 40mg IV in OT where no contraindications.
• Start celecoxib 200mg bd the following day.
• Morphine PCA  1 mg bolus usual dose with 5 minute lockout interval, continue for 24-48 hrs.
• When the PCA is ceased change to oxycodone CR 10 mg BD PRN with oxycodone 5 mg 4/24 PRN for breakthrough pain
  
• Tramadol 50 – 100mg PO/IM PRN 6/24 (or IV slowly over 10 mins to avoid nausea /vomiting)
  

Comment 1

 I find more than 1 mg/kg of tramadol inta-operatively makes patients too drowsy in recovery.

Comment 2

I use a single shot technique (preop) as the small semi-rural hospital I work at doesn't stock them.