After hip replacement, most people receive a combination of pain medications rather than a single drug. The current standard approach pairs acetaminophen (Tylenol) and an anti-inflammatory medication as the foundation, with opioids reserved for breakthrough pain in the first few days. This combination strategy reduces the amount of any single drug you need, which means fewer side effects overall.
The Core Medications: Acetaminophen and Anti-Inflammatories
The two drugs you’ll almost certainly take are acetaminophen and a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, or celecoxib. These work through different pathways, so together they control pain better than either one alone. Current guidelines from PROSPECT, a European surgical pain group, specifically recommend this acetaminophen-plus-NSAID combination as the backbone of hip replacement pain management.
A common schedule involves taking acetaminophen every six hours and ibuprofen every six hours, staggered so you’re alternating between the two every three hours. This keeps a steady level of pain relief in your system. Most surgeons recommend staying on this schedule for the first three to four days rather than waiting until pain builds up before taking anything. Staying ahead of the pain is far more effective than chasing it.
Some surgeons prescribe celecoxib instead of ibuprofen. Celecoxib is a more targeted anti-inflammatory that tends to cause less stomach irritation. It also serves a second purpose after hip surgery: reducing the risk of heterotopic ossification, a condition where bone tissue grows in the soft tissue around the new joint. When used for this purpose, it may be prescribed for up to six weeks.
What You’ll Get in the Hospital
In the first 24 hours after surgery, your pain management starts before you’re even fully awake. During the procedure, your surgeon typically injects a long-acting numbing medication directly into the tissues around your new hip joint. This is called local infiltration analgesia, and it can keep the surgical area relatively comfortable for the first several hours.
While you’re still in the hospital, you may receive intravenous acetaminophen (usually 1 gram given three to four times) and sometimes an IV anti-inflammatory. Studies on hip surgery patients found that IV non-opioid medications reduced opioid use by a meaningful amount in the first 24 hours compared to patients who didn’t receive them. You may also receive a single dose of a steroid called dexamethasone through your IV, which has been shown to lower both pain intensity and nausea after hip replacement.
Regional nerve blocks are more commonly associated with knee replacement than hip replacement, but some anesthesiologists use them for hip procedures as well. If you receive one, it involves an injection of numbing medication near specific nerves that supply the hip area, providing hours of targeted relief.
Opioids: When They’re Used and For How Long
Most people do need some opioid medication in the first few days after hip replacement, particularly for pain that breaks through the acetaminophen and anti-inflammatory regimen. Common options include oxycodone, hydrocodone, or tramadol in pill form. The goal is to use the lowest effective dose for the shortest time possible.
CDC guidelines recommend that opioid prescriptions after major surgery match the expected duration of severe pain, not a standard number of pills. For hip replacement, this typically means a prescription covering roughly five to seven days of as-needed use, though individual needs vary. Your surgeon won’t prescribe extra “just in case” pills, which is a deliberate guideline to reduce the risk of prolonged use.
If you end up taking opioids around the clock for more than a few days, your body can develop physical dependence quickly enough that stopping abruptly causes withdrawal symptoms like anxiety, sweating, and rebound pain. In that situation, a gradual reduction works better than stopping cold turkey. The FDA recommends reducing the dose by no more than 10 to 25 percent every two to four weeks for patients who’ve become physically dependent, though most hip replacement patients won’t reach that point if opioids are used sparingly.
Nerve Pain Medications
Some surgical teams include gabapentin or pregabalin in their pain protocol. These medications target nerve-related pain and were initially developed for seizures. The evidence for their benefit after hip replacement is mixed. The American Association of Hip and Knee Surgeons reviewed the available studies and found that short courses of gabapentin (less than a week) had no measurable impact on postoperative pain after joint replacement. Longer courses of pregabalin showed some potential benefit, but the group’s consensus is that if these drugs are used at all, the lowest effective dose should be prescribed to minimize side effects like dizziness and drowsiness.
Managing Opioid Side Effects
Constipation is one of the most common and uncomfortable side effects of opioid pain medication after hip replacement. Opioids slow down your entire digestive tract, and the reduced mobility after surgery makes it worse. Most surgical teams will recommend or prescribe a stool softener or mild laxative like lactulose or magnesium oxide from the start, rather than waiting for constipation to develop.
On your end, increasing fiber through fruits, vegetables, and whole grains helps, along with drinking plenty of water. Small, frequent meals are easier on your system than large ones. Getting up and moving as early as your surgical team allows is one of the most effective ways to get your gut working again. Nausea is another common opioid side effect, and it’s one reason your team prioritizes non-opioid medications. Studies show that using NSAIDs and dexamethasone significantly reduces nausea after hip replacement.
How Blood Thinners Affect Your Options
After hip replacement, you’ll also take a blood thinner to prevent blood clots. This is separate from pain management but directly affects which pain medications are safe for you. Many surgeons now use aspirin for clot prevention after joint replacement, as recent research confirms it’s as effective as stronger anticoagulants for most patients, with no significant difference in bleeding or wound complications. Aspirin is also cheaper and doesn’t require blood monitoring.
If you’re on aspirin alone, NSAIDs like ibuprofen or celecoxib are generally still an option, though your surgeon will weigh the combined effect on your stomach lining. If you’re on a stronger blood thinner, your team may limit NSAID use because both drug classes increase bleeding risk. In that case, your pain plan may lean more heavily on acetaminophen and short-term opioids.
What the First Few Weeks Look Like
Pain after hip replacement follows a predictable arc for most people. The first three to five days are the most intense, which is when you’ll rely on the full combination of scheduled acetaminophen, anti-inflammatories, and as-needed opioids. By the end of the first week, many people find they can drop the opioids entirely or use them only at night.
Through weeks two and three, most people manage well on just acetaminophen and an anti-inflammatory. By four to six weeks, many patients need only occasional over-the-counter pain relief, primarily after physical therapy sessions or more active days. The surgical pain itself is largely resolved by this point, though stiffness and muscle soreness from rehabilitation can persist longer. Your prescribed anti-inflammatory may continue through the six-week mark if your surgeon is using it to prevent abnormal bone growth around the joint.