1 8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5
STANDARDIZED DOSES
UC Irvine's
Pain-Control Protocol
In pre-op:
Initiate oral pain protocol
• acetaminophen 1,000 mg PO NOW
• oxycodone sustained release 10 or 20 mg PO
NOW
• gabapentin 300 or 600 mg PO NOW
• Celecoxib 200 or 400 mg PO NOW (patients
with serious allergy or intolerance receive
etodolac 500 mg orally)
In the OR:
•
Administer preferred spinal anesthetic: 0.75%
bupivacaine 1.4 to 1.6 mg with fentanyl 20 mcg
and low-dose propofol IV infusion.
• Intraop periarticular mixture total
100 ml once in divided doses:
- epinephrine 1 mg/ml; 0.5 ml
- ketorolac 30 mg/ml; 1 ml
- clonidine 100 mcg/ml; 0.8 ml
- ropivacaine 5 mg/ml; 49.25 ml
- sodium chloride 0.09%; 48.45 ml
• 1 dose of IV ketorolac 15 mg
In post-op:
•
acetaminophen 1,000 mg
plus oxycodone 10 mg orally
• PRN VAS pain score = 4
• opiates PRN; dilaudid in divided doses
In the patient care unit:
• acetaminophen 1,000 mg orally every 8 hours
around the clock, not to exceed 4 g per 24 h.
• oxycodone sustained released 10 or 20 mg
orally every 12 hours
• gabapentin 300 mg orally every night at bed-
time, with adjustments for renal impairment
• tramadol 50 mg orally every 6 hours PRN for
mild pain (used with caution in patients with
seizure history)
• oxycodone immediate release 5 mg orally
every 4 hours PRN for moderate pain
• oxycodone immediate release 10 mg orally
every 4 h PRN for severe pain
• ketorolac 7.5 mg IV every 6 hours x 2 doses
started 6 hours after surgery
• hydromorphone 0.2 to 0.4 mg IV push
every 2 hours PRN breakthrough pain
— Zeev Kain, MD, MBA
