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