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

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

  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