Joint Replacement
Opioid Naive/No Block
Preop
Gabapentin 600 mg
Acetaminophen 1000 mg
Oxycontin 10 mg (or patient's usual AM dose)
Celecoxib 400 mg
Intraop
Magnesium 2 g bolus
Ketamine 0.3 mg/kg bolus
Lidocaine (IV) 1mg/kg bolus + 1mg/kg/h
PACU (PRN)
Hydromorphone 0.2 mg IV q15min for pain 3-5
Hydromorphone 0.4 mg IV q15min for pain 6-8
Fentanyl 50 mcg IV q10min for pain 9-10
Opioid Naive/Regional Block
Preop
Gabapentin 600 mg
Acetaminophen 1000 mg
Oxycontin 10 mg (or patient's usual AM dose)
Celecoxib 400 mg
Intraop
Magnesium 2 g bolus
Ketamine 0.3 mg/kg bolus
PACU (PRN)
Hydromorphone 0.2 mg IV q15min for pain 3-5
Hydromorphone 0.4 mg IV q15min for pain 6-8
Fentanyl 50 mcg IV q10min for pain 9-10
Pre-op Opioids/No Block
Preop
Gabapentin 600 mg
Acetaminophen 1000 mg
Oxycontin 10 mg (or patient's usual AM dose)
Celecoxib 400 mg
Intraop
Magnesium 2 g bolus + 10 mg/kg/h
Ketamine 0.3 mg/kg + 10 mg/h
Lidocaine (IV) 1mg/kg bolus + 1mg/kg/h
PACU (PRN)
Hydromorphone 0.4 mg IV q15min for pain 3-5
Hydromorphone 0.8 mg IV q15min for pain 6-8
Fentanyl 100 mcg IV q10min for pain 9-10
Pre-op Opioids/Regional Block
Preop
Gabapentin 600 mg
Acetaminophen 1000 mg
Oxycontin 10 mg (or patient's usual AM dose)
Celecoxib 400 mg
Intraop
Magnesium 2 g bolus + 10 mg/kg/h
Ketamine 0.3 mg/kg bolus + 10mg/h
PACU (PRN)
Hydromorphone 0.4 mg IV q15min for pain 3-5
Hydromorphone 0.8 mg IV q15min for pain 6-8
Fentanyl 100 mcg IV q10min for pain 9-10
APFEL Scoring for PONV
(1 point for each)
Female gender
No smoking status
Anticipated use of opioids after Sx
h/o PONV or motion sickness
0-2 = Dexamethasone + Ondansetron
3 = + Scopolamine
4 = + propofol infusion or TIVA