Postoperative pain control after total knee or hip arthroplasty (TKA/THA) is a major concern. Inadequate postoperative analgesia can negatively influence surgical outcome and duration of rehabilitation. Routine use of intravenous patient controlled analgesia (IV PCA) after TKA and THA can result in substantial functional interference and side effects. Following successful implementation in our setting of a novel oral perioperative opioid regimen¹, the pain management program was further revised to include use of preoperative gabapentin and acetaminophen, with intraoperative dolasetron, and scheduled postoperative acetaminophen for all patients undergoing elective TKA and THA . Three groups of 52 patients were compared: Group 1 received IV PCA; Group 2 received only scheduled long-acting and as needed short-acting oral opioids postoperatively; Group 3 received the perioperative oral multimodal regimen. Patient surveys and chart audits were used to measure pain intensity, functional interference from pain, opioid consumption, analgesic-related side effects, and patient satisfaction. Patients who received the new perioperative, multimodal oral regimen had significantly less opioid consumption, nausea, and itch (p<0.05) than the IV PCA group. Although not significant, patients who received the new regimen tended to report less pain and interference with sleep, and were more satisfied than patients who received oral opioid alone. This study demonstrates some significant advantages of a multimodal perioperative oral analgesic regimen compared with standard IV PCA or oral opioids used alone after TKA and THA. 1. Illgen R, Pellino TA, Gordon DB, Butts S, Heiner JP. Prospective analysis of a novel long-acting oral opioid analgesic regimen for pain control after total hip and knee replacement. The Journal of Arthroplasty. 2006;Vol. 21(6):814-820