Giving patients Tylenol (1,000 mg) and meloxicam (15 mg) as a pri-
mary treatment and oxycodone as needed for breakthrough pain is at
least as effective as opioids alone and avoids opioid-related side
effects that can delay recovery and discharge.
• Proactive PONV prevention. Administering IV dexamethasone 8
mg after anesthesia induction and a 5 hydroxytryptamine-3 (5HT3)
antagonist, such as IV ondansetron 4 mg, at the end of procedures
should be used at the minimum to prevent PONV in most patients.
Transdermal scopolamine or IV haloperidol during surgery might be
needed to settle the stomachs of high-risk patients. Long-acting 5HT3
antagonists such as palonosetron can prevent post-discharge nausea
and vomiting, a key concern among providers in outpatient surgical
facilities.
• Expertise in
regional blocks.
Anesthesiologists
advance pain man-
agement by placing
local and regional
blocks that provide
effective pain relief
after major proce-
dures. Single-shot
adductor canal and
popliteal-sciatic nerve
blocks are helping to
move knee replace-
ments and major foot
and ankle procedures
to outpatient facili-
J U L Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 7