Before, during, and after knee replacement surgery, surgeons may prescribe different medications. For example, pain medication can relieve discomfort, and blood thinners prevent blood clots.

Skin and soft tissue infections requiring antibiotic treatment may occur after surgery.

This article provides an overview of knee replacement surgery medications that doctors prescribe after the operation.

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People who need total knee replacement surgery can expect moderate to severe pain after the operation. Doctors prescribe pain medications to help relieve pain and assist people throughout the recovery process.

They may prescribe opioids, which are powerful painkillers. However, they can cause undesirable side effects, such as nausea, trouble breathing, and difficulty urinating. Opioids can also be addictive.

Experts suggest using combinations of different pain medications.

Different drugs act on specific pain pathways involved in postoperative pain. People may experience better pain relief and improved satisfaction when combining both opioid and non-opioid drugs.

Pain management often starts before the operation. Taking certain pain medications before surgery can help prevent pain receptors from entering a state of hyperalgesia, which is an extreme response to pain. This may include taking celecoxib (Celebrex), pregabalin (Lyrica), or acetaminophen combined with tramadol.

During surgery, anesthesiologists may use local infiltration analgesia. This prevents pain signals from generating at the incision.

Local infiltration analgesia combines a cocktail of different drugs, including opioids, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or epinephrine. Currently, there is no standard cocktail of drugs used for local infiltration analgesia.

Muscle relaxants include methocarbamol and cyclobenzaprine. Methocarbamol is available by prescription and is combined with ibuprofen or acetaminophen. Cyclobenzaprine is also a prescription drug.

Doctors may prescribe or recommend muscle relaxers to limit opioid use after knee replacement surgery.

For example, muscle relaxers, such as tizanidine (Zanaflex), can help manage muscle spasms. Researchers are currently studying whether adding tizanidine after knee replacement surgery helps further reduce opioid use.

Venous thromboembolism (VTE), a blood clot that forms within veins, may occur after major surgery. This is a serious condition that can cause severe disease and even death from stroke or heart attack.

To prevent blood clots after knee replacement surgery, doctors typically recommend aspirin or direct oral anticoagulants. Direct oral anticoagulants approved by the Food and Drug Administration (FDA) include rivaroxaban (Xarelto) and apixaban (Eliquis).

Dabigatran (Pradaxa) and edoxaban (Savaysa) are two other anticoagulants that have not received FDA approval for preventing blood clots after knee replacement surgery. However, sometimes, doctors use them off-label.

People who cannot take direct oral anticoagulants may use low-molecular-weight heparin injections to prevent blood clots.

Rarely, people may develop an infection after knee replacement surgery. Infections may occur at the incision site or around the knee replacement components.

Bacteria can stick to metal implants. Therefore, the immune system has difficulty attacking bacteria around the metal components of a knee replacement.

If only the skin and soft tissues around the knee replacement are infected, antibiotics are effective. Oral or intravenous (IV) antibiotics may treat these types of superficial infections.

However, if the infection spreads to the joint, a person may need surgery to wash out the bacteria in the joint. A surgeon will remove any contaminated tissues as well.

After this surgery, doctors prescribe IV antibiotics to prevent any further infections. If a person has severe or chronic infections, surgeons may need to remove the knee implant.

During knee replacement surgery, people are put under general anesthesia and are temporarily unconscious. General anesthesia acts on the central nervous system to block sensations during surgery.

The medications used depend on the doctor’s preferences and the individual’s past experiences with general anesthesia. For example, if a person has had an allergic reaction to a particular medication in the past, they will choose an alternative.

Discussing knee replacement surgery medications with a doctor can help ensure people have the most effective pain relief after the operation.

Understanding the reason for requiring blood thinners and how to prevent blood clots can help reduce disease and possible death after knee replacement surgery.

Here is a list of possible questions to ask a doctor before or after knee replacement surgery:

  • What is the best combination of pain medications to take before surgery to prevent severe pain after surgery?
  • What are the risks of having general anesthesia?
  • When can I stop taking my anticoagulant?
  • Will I need to take aspirin with an anticoagulant to prevent blood clots after surgery?
  • How can I prevent infections after knee replacement surgery?
  • Would a muscle relaxant help reduce knee pain after surgery?
  • Do any of the knee replacement surgery medications interfere with my regular medications?

Doctors prescribe different medications before, during, and after knee replacement surgery. This can include pain relievers, antibiotics, and blood thinners.

Following the medication regimen for pain relief and blood clot prevention is an important part of life after knee replacement surgery.