Post-Operative Medications

Controlling pain after surgery is critical for starting your path to recovery, and our understanding of how to effectively control pain after orthopedic surgeries has evolved significantly. Multi-modal pain management involves using multiple types of medications to target different pain pathways in your body. While this does result in you taking more medications after surgery, patients are often much happier as their pain is better controlled, all while using less opioid medications.

In addition to medications for pain, I also prescribe medications to minimize common post-operative side effects, decrease the risk of blood clots, and enhance healing after surgery, such as Vitamin D and C.

I recommend reviewing the information on these medications before your surgery. A copy of this information will also be provided to you as part of your Pre-Operative Information Packet. This packet will be provided to you either in the office before surgery or at the hospital the morning of surgery.

Pre-Operative Nerve Blocks

As part of the multi-modal pain management, many patients will receive a nerve block by the anesthesia team the morning of their surgery. These blocks are effective at reducing pain during and after surgery, and they may also affect your ability to move operative arm or leg until the block as worn off. These blocks tend to last anywhere from 12-36 hours. As these blocks wear off, a sharp increase in pain is possible. Therefore, it is important that you start taking your prescribed pain medications as soon as you are discharged from the hospital, even if the block is still working and you have no pain. This will help decrease the risk of that sharp "rebound" pain when the block does eventually wear off.

Post-Operative Medications

Instructions:

Please take all medications as prescribed on the package and refer to the information below for each medication. These medications will be sent to your pharmacy prior to or the day of surgery. If you have any questions, do not hesitate to contact my office.

General information:

Narcotic/opioid medications: Minimize narcotic (opioid) pain medication as much as possible and stop the medication as soon as possible. This type of medication should only be used for severe pain when the other medications listed are not relieving the pain. Ideally you will be off narcotic medications completely within 1-2 weeks from surgery. These medications become less effective over time as patients develop tolerance.
Pain management contracts: You must notify us at the time of your visit if you are under a pain management contract with a pain management specialist who prescribes your narcotic pain medication. This pain specialist will need to be the provider who prescribes your narcotic pain medication after surgery.
Non-steroidal anti-inflammatory drugs (NSAIDs): When prescribed an NSAID, do not take over-the-counter or previously prescribed NSAIDs in addition to your current NSAID. This could cause damage to your stomach and/or kidneys. Commonly used NSAIDs include meloxicam, naproxen, Celebrex, diclofenac, ketorolac/Toradol, ibuprofen, Advil, alleve, and BC powder.
Driving: Do not drive while you are taking narcotic pain medication.
Keeping up with your pain medication: I recommend making a spreadsheet or taking notes of when you took a certain medication and when you can take the next dose to help keep your medications organized.
When to stop medications:
- I recommend taking all “daily” medications (Meloxicam, Tylenol, Flexeril, Tramadol) for at least 14 days and then begin weaning off the medications as your pain tolerates.
- If you are prescribed Aspirin, Medrol Dosepak, Vitamin D, or Vitamin C, then you should complete the prescribed course (take all medications per directions, until they are gone).

Medications To Take Daily

Meloxicam – 15mg once daily (30 days)

This is an NSAID (non-steroidal anti-inflammatory) medication
Do not take this medication with other prescribed NSAIDs (e.g. meloxicam, naproxen, diclofenac, Toradol) or over-the-counter NSAIDs (e.g. ibuprofen, advil, alleve, BC powder)
STOP this medication if you develop severe stomach pain when taking
Do not take this medication if you have a history of gastric (stomach) ulcers; history of gastric bypass surgery; are currently on a blood thinner such as Eliquis, Xarelto, or Warfarin (excluding aspirin and/or Plavix); or you have chronic kidney disease

Tylenol – 1000mg every 8 hours (30 days)

Flexeril (cyclobenzaprine) – take one 5mg tablet every 8 hours (30 days)

This is a muscle relaxer

Tramadol – take one 50mg tablet every 6 hours (14 days)

This is a low strength opioid medication
You should not take this medication if you are currently taking depression or anxiety medications as this may cause a serious side effect

Vitamin D – take one 50,000 IU tablet every week (12 weeks)

This medication helps with bone healing after surgery

Medications To Take Only As Needed

Docusate (Colace) – 100mg twice daily as needed for constipation

This is a stool softener.
This can help prevent constipation that may occur after anesthesia or while taking narcotic pain medications
You may stop this medication when you are off the narcotic pain medication or if you are not constipated

Zofran (Ondansetron) – 4mg tablets every 4 hours as needed for nausea/vomiting

This medication can help with post-operative nausea and vomiting that may occur after anesthesia or while taking narcotic pain medication
You may use this as needed for nausea or vomiting

Oxycodone – 5mg tablet every 6 hours as needed for pain

This is a narcotic (opioid) pain medication
Certain patients may not be prescribed any or fewer tablets of oxycodone depending on the type of surgery they undergo
Use this medication as a last resort if the other pain medications do not help relieve severe pain
Common side effects: nausea/vomiting, itching, constipation, drowsiness
Do not take this medication with alcohol
Do not drive while taking this medication

Medications You May Be Prescribed Depending On Your Surgery

Aspirin – 81mg once or twice daily

This medication is to help prevent your risk of a blood clot after surgery
Surgeries involving the legs: most patients will be prescribed 81mg aspirin (if not currently on a blood thinner) that should be taken twice daily for 6 weeks
Surgeries involving the arms: most patients will not be prescribed this medication. If you are having a shoulder or elbow replacement, then I will prescribe 81mg aspirin to be taken once daily for 2 weeks

Vitamin C – take 500mg every day (30 days)

This medication will typically be prescribed to patients undergoing hand/wrist or foot/ankle surgery as it may help with pain control, and also assist with healing after surgery

Medrol dosepak – take per instructions on packet

This is steroid medication that can help with pain control
This medication may be prescribed to you depending on the type of surgery you undergo
If you are diabetic, please monitor your blood sugar levels while on this medication, as it may dangerously raise your blood sugar levels

Antibiotics

The vast majority of patients do not need antibiotics after they leave the hospital
Patients with certain medical conditions undergoing joint replacement surgery may be prescribed a short dose of antibiotics to decrease their risk of infection

Post-Operative Medications

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