Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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1 8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5 STANDARDIZED DOSES UC Irvine's Pain-Control Protocol In pre-op: Initiate oral pain protocol • acetaminophen 1,000 mg PO NOW • oxycodone sustained release 10 or 20 mg PO NOW • gabapentin 300 or 600 mg PO NOW • Celecoxib 200 or 400 mg PO NOW (patients with serious allergy or intolerance receive etodolac 500 mg orally) In the OR: • Administer preferred spinal anesthetic: 0.75% bupivacaine 1.4 to 1.6 mg with fentanyl 20 mcg and low-dose propofol IV infusion. • Intraop periarticular mixture total 100 ml once in divided doses: - epinephrine 1 mg/ml; 0.5 ml - ketorolac 30 mg/ml; 1 ml - clonidine 100 mcg/ml; 0.8 ml - ropivacaine 5 mg/ml; 49.25 ml - sodium chloride 0.09%; 48.45 ml • 1 dose of IV ketorolac 15 mg In post-op: • acetaminophen 1,000 mg plus oxycodone 10 mg orally • PRN VAS pain score = 4 • opiates PRN; dilaudid in divided doses In the patient care unit: • acetaminophen 1,000 mg orally every 8 hours around the clock, not to exceed 4 g per 24 h. • oxycodone sustained released 10 or 20 mg orally every 12 hours • gabapentin 300 mg orally every night at bed- time, with adjustments for renal impairment • tramadol 50 mg orally every 6 hours PRN for mild pain (used with caution in patients with seizure history) • oxycodone immediate release 5 mg orally every 4 hours PRN for moderate pain • oxycodone immediate release 10 mg orally every 4 h PRN for severe pain • ketorolac 7.5 mg IV every 6 hours x 2 doses started 6 hours after surgery • hydromorphone 0.2 to 0.4 mg IV push every 2 hours PRN breakthrough pain — Zeev Kain, MD, MBA

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