The rising tide of opioid use and abuse: the role of the anesthesiologist

Table 1 Opioid-reducing enhanced recovery pathway. This is the protocol used at the authors’ institution for multimodal, opioid-reducing analgesia

	Duration of surgery
Drug	Short (1–2 h)	Long (> 2 h)	Notes
Preoperative (day prior)
Tylenol	975 mg TID	975 mg TID
Ibuprofen	800 mg TID	800 mg TID
Holding room
Gabapentin	600 mg	600 mg
Celebrex	450 mg	450 mg
Tylenol	975 mg	975 mg
Glycopyrolate	0.2–0.3 mg	0.2–0.3 mg
Intraoperative
Induction
Ketamine	Bolus	Bolus and infusion	Bolus 0.25 mg/kg Infusion 4 μg/kg/min
Lidocaine	Bolus	Infusion	Bolus 1 mg/kg Infusion 1 mg/kg/h
Dexmetatomidine		Bolus and infusion	Bolus 1 μg/kg Infusion 0.1 μg/kg/h
Magnesium	Bolus	Bolus and infusion	Bolus 2 g Infusion 1 g/h
Analgesics (provider discretion)
Toradol	Bolus	Bolus	15–30 mg
Hydromorphone	Bolus	Bolus	0.2–0.4 mg
Morphine	Bolus	Bolus	0.06–0.1 mg/kg
PACU
Analgesics
Fentanyl	25 μg/dose	25 μg/dose
Hydromorphone	0.2–0.4 mg/dose	0.2–0.4 mg/dose
Morphine	4 mg/dose	4 mg/dose
Antiemetics
Zofran	4 mg	4 mg
Dexamethasone	4–8 mg	4–8 mg
Haldol	1–2 mg	1–2 mg
Benadryl	6.25 mg	6.25 mg

ISSN: 2047-0525