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Below you will find our preop, intraop, and postop recommended pain management strategy for the following procedures:

Laparoscopic cholecystectomy

Preop (1 hr. before surgery) 

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs

  2. Ketorolac 15-30 mg IV q6-8 hrs. Or Ibuprofen (NSAIDs) 400 mg q8 hrs.

  3. Gabapentin 100 mg PO TID

  4. Lidoderm patch every 12 hrs. at the site of laparoscopic incision

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs. Prn + Oxycodone 5 mg PO q 4 hrs. Prn for pain+25 mcg fentanyl IV q3hrs. For extreme pain

  • Tramadol 50 mg q 6 hrs. Prn + Dilaudid 2 mg PO q4 hrs. Prn for pain+25 mcg fentanyl IV q3hrs. For extreme pain

Postop discharge

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn q8hrs for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. For 3 days followed by q8 hrs. Prn for pain.

  3. Gabapentin 100 mg PO TID for one week/ Gabapentin 100 mg PO at bed time for 14
    days

  4. Lidoderm patch every 12 hrs. at the site of laparoscopic incision

Laparoscopic inguinal hernia repair, unilateral

Preop (1 hr. before surgery) 

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop inpatient standing orders

  1. Acetaminophen 1g PO q8hrs

  2. Ketorolac 15-30 mg IV q6-8 hrs. Or Ibuprofen (NSAIDs) 400 mg q8 hrs

  3. Gabapentin 100 mg PO TID

  4. Lidoderm patch every 12 hrs at the site of laparoscopic incision

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs. Prn + Oxycodone 5 mg PO q 4 hrs. Prn for pain+25 mcg fentanyl IV q3hrs. For extreme pain

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Open Inguinal hernia repair, unilateral

Preop (1 hr. before surgery)

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 7 days = 28 pills

  • Oxycodone 5 mg PO q12 hrs prn for 7 days = 14 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =14 pills

Open umbilical hernia repair

Preop (1 hr. before surgery) 

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 7days = 28 pills

  • Oxycodone 5 mg PO q12 hrs prn for 7 days = 14 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =14 pills

Arthroscopic partial menisectomy

Preop (1 hr. before surgery)

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Arthroscopic ACL/PCL repair

Preop (1 hr. before surgery)

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Open hysterectomy

Preop (1 hr. before surgery)

1g PO Acetaminophen / 600 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 7 days = 28 pills

  • Oxycodone 5 mg PO q12 hrs prn for 7 days = 14 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 7 days =14 pills

MIS hysterectomy

Preop (1 hr. before surgery)

1g PO Acetaminophen / 600 mg PO Gabapentin

Intraop

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

  4. Lidoderm patch every 12 hrs at the site of laparoscopic incision

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Uncomplicated Cesarean section

Preop (1 hr. before surgery)

1g PO Acetaminophen

Intraop 

------

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

 

Postop narcotics prn only (prescribe one only)

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Robotic retropubic prostatectomy

Preop (1 hr. before surgery)

1g PO Acetaminophen / 600 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

  4. Lidoderm patch every 12 hrs at the site of laparoscopic incision

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Partial mastectomy without sentinel lymph node biopsy

Preop (1 hr. before surgery) 

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Thyroidectomy, partial or total

Preop (1 hr. before surgery) 

1g PO Acetaminophen / 300 mg PO Gabapentin

Intraop 

IV Ketorolac 15-30 mg one time (at conclusion of surgery)

Postop standing orders

  1. Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.

  2. Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only

  3. Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days

 

Postop narcotics prn only (prescribe one only)

  • Tramadol 50 mg q 6 hrs prn for 5 days = 20 pills

  • Oxycodone 5 mg PO q12 hrs prn for 5 days = 10 pills

  • Or Dilaudid 4 mg PO q12hrs prn for 5 days =10 pills

Please Note

All pathways above should be considered in the context of relative patient contraindications and individual patient scenarios, including the consideration of patient weight, metabolism, patient goals, medication side effects and potential interactions with other medications and medical conditions patients may have. Doses given are local recommendations. Adjustments may be required for individual patients.

Some examples of relative contraindications:

  1. Gabapentin: must dose renally in kidney disease

  2. Acetaminophen : contraindicated with liver disease or elevated LFTs

  3. NSAIDS: contraindicated with bleeding risks, GI ulcers and Kidney disease

COX-2 Selective Inhibitor, Celecoxib

Give to postop patients who are unable to receive ketorolac because they have a history of GI ulcers or bleeding. Also give preop to orthopedic patients who do not have any contraindications.

Dosing: Give 200 mg 1-2 hours before surgery and every 12 hours for 5 days. Decrease daily dose by 50% in patients with hepatic impairment (Child-Pugh Class B).

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