is a drug shortage;
then I'll use bupiva-
caine.
Intra-op: General
anesthesia with endo-
tracheal tube.
Administer the keta-
mine, magnesium and
lidocaine infusion
together to help with surgical pain during and after the procedure for
a narcotic sparing technique. Inhaled anesthetic gas at a reduced per-
centage for maintenance.
Post-op: Overall goal for pain management is to provide superior
analgesia without the need for opioids. An interscalene nerve block
with catheter will drastically reduce pain for 3 days using a 0.2%
ropivacaine infusion at 8-10 mL/hr. Depending on the patient's risk
factors, schedule gabapentin or Tylenol 3 times a day for post-op
pain management. 15-30 mg Toradol can be given for any break
through pain. This regiment typically helps get our patients home a
day sooner than expected due to superior pain control.
Mr. Bland explains:
Pre-op: Give the APAP IV with the celecoxib and gabapentin.
Intra-op: The surgeon will initiate an Exparel infiltration and will
inject the encapsulated bupivacaine into the planes of the tissue. This
is usually adequate to keep the patient pain free through post-op for 3
days. If necessary, give ketamine, decadron or 2mg of magnesium sul-
M a r c h 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 9 5
Adam Schneider, CRNA
Pre-op
• 1000 mg Tylenol
• 100 mcg clonidine
• 300 mg gabapentin
Intra-op
• 0.25 mg/kg/hr ketamine
• 250-500 mg/hr magnesium
• 1.0 mg/kg/hr lidocaine
Post-op
8-10 ml/hr 0.2% ropivacaine
15-30 mg toradol (optional)
Shoulder
Anesthesia Maintenance: Inhaled anesthetics at a reduced MAC
