Laparoscopic Colpopexy

Younger Patient/Opioid Naive

Preop

Gabapentin 600 mg

Acetaminophen 1000 mg

Intraop

Magnesium 2 g bolus + 10 mg/kg/h infusion

Ibuprofen 600mg IV Bolus

Ketamine 20 mg IV 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

Younger Patient/Pre-op Opioids

Preop

Gabapentin 600 mg

Acetaminophen 1000 mg

Oxycontin 10 mg (or patient's usual AM dose)

Intraop

Magnesium 2 g bolus + 10 mg/kg/h

Ibuprofen 800 mg IV

Ketamine 20 mg IV Bolus + 10 mg/h infusion

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

Senior Patient/Opioid Naive

Preop

Gabapentin 300 mg

Acetaminophen 1000 mg

Intraop

Magnesium 2 g bolus

Ibuprofen 600mg IV Bolus

PACU (PRN)

Hydromorphone 0.1 mg IV q15min for pain 3-5

Hydromorphone 0.2 mg IV q15min for pain 6-8

Fentanyl 25 mcg IV q10min for pain 9-10

Senior Patient/Pre-op Opioids

Preop

Gabapentin 300 mg

Acetaminophen 1000 mg

Oxycontin 5 mg (or patient's usual AM dose)

Intraop

Magnesium 2 g bolus + 10 mg/kg/h

Ibuprofen 600mg IV

PACU (PRN)

Hydromorphone 0.3 mg IV q15min for pain 3-5

Hydromorphone 0.6 mg IV q15min for pain 6-8

Fentanyl 75 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

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