Nonopioid analgesics for all patients | |
Acetaminophen |
|
NSAIDs |
|
Patients who have neuraxial anesthesia | |
Neuraxial opioid | Preservative-free opioid:
|
Oral opioid | Oxycodone 2.5 to 5 mg orally every 4 hours as needed for breakthrough pain:
|
Patients who have general anesthesia, or neuraxial anesthesia without neuraxial opioid | |
Nerve block OR Wound infiltration | Bilateral TAP or QL block:
Wound infiltration: Subfascial (preferred) or subcutaneous wound catheter, 0.5% bupivacaine or ropivacaine 4 to 5 mL/hour |
Opioids |
|
For severe or ongoing pain, options | |
Rescue nerve block | Bilateral TAP or QL block as above: 0.25% bupivacaine or 0.2% ropivacaine; consider liposomal bupivacaine |
Opioids |
|
Nonopioid adjuncts | Gabapentin 200 mg orally every 8 hours for 5 doses; enhanced respiratory monitoring may be necessary |
IV: intravenous; NSAIDs: nonsteroidal anti-inflammatory drugs; VNPS: verbal numerical pain score; TAP: transversus abdominus plane; QL: quadratus lumborum; PCA: patient-controlled analgesia; PACU: post-anesthesia care unit.
* For patients who have combined spinal epidural anesthesia, intrathecal morphine is preferred, rather than epidural morphine, to minimize opioid dose and systemic absorption.
¶ When nursing resources are available, the use of "split-dose" opioid order sets can reduce total opioid consumption.
Δ When liposomal bupivacaine is mixed with aqueous bupivacaine, the dose of bupivacaine must be <50% of the dose of liposomal bupivacaine. Liposomal bupivacaine should not be mixed with other local anesthetics except for aqueous bupivacaine.Do you want to add Medilib to your home screen?