Radical Cystectomy

Opioid Naive/No Block

Preop

Gabapentin 600 mg

Acetaminophen 1000 mg

Intraop

Magnesium 2 g bolus

Ketamine 0.3 mg/kg bolus

Lidocaine (IV) 1mg/kg bolus + 1mg/kg/h

Ibuprofen 800 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

Opioid Naive/Regional Block

Preop

Gabapentin 600 mg

Acetaminophen 1000 mg

Intraop

Magnesium 2 g bolus

Ketamine 0.3 mg/kg bolus

Ibuprofen 800 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

Pre-op Opioids/No Block

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

Ketamine 0.3 mg/kg + 10 mg/h

Lidocaine (IV) 1mg/kg bolus + 1mg/kg/h

Ibuprofen 800 mg IV bolus

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)

Intraop

Magnesium 2 g bolus + 10 mg/kg/h

Ketamine 0.3 mg/kg bolus + 10mg/h

Ibuprofen 800 mg IV bolus

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

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