Chinese Association of Idaho State University (CAISU)
Multimodal pain management is now touted as the state-of-the-art mechanism to treat post-operative pain. This is a combination of short-acting opioids and pre-operative drug 'cocktails' that act as nerve blocks. These are used as an alternative to the heavy-hitters like Fentanyl or morphine since their effects on the body are typically less severe.
The movement is now moving towards administering non-opioids as a pain management device. Coxibs, (like celecoxib) Acetaminophen are a few which can be taken intraveneously or orally before surgery. Although many patients do not properly absorb medication taken orally pre-procedure due to higher levels of anxiety.
Some orthopaedic surgeons are electing to forego pre-operative administration and are instead using a spinal anaesthetic, consisting of an intraoperative periarticular injection of local anaesthetics. During the surgery, and for 24 hours following it, Acetaminophen is administered intraveneously in conjuction with some non-steroid medication (if appropriate) and a minimal dose of short-acting opioids taken orally.
The ultimate goal after any orthopaedic surgery is to minimise the pain and discomfort suffered by the patient. The mental 'mountains' are often far more difficult to climb then the physical ones, and patients who become dependent on opioids to manage their recovery may find that reliance actually has the opposite effect. Non opioid medications like ketamine and Precedex can decrease post-operative pain to a manageable level allowing the patient to recover without succumbing to the effects of opioids in the body. Nerve blocks are also becoming more widely used after hand, foot, ankle and other sporting-related surgeries since it often allows the patient to return home hours after the surgery has been successful.