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
-
Acetaminophen 1g PO q8hrs
-
Ketorolac 15-30 mg IV q6-8 hrs. Or Ibuprofen (NSAIDs) 400 mg q8 hrs.
-
Gabapentin 100 mg PO TID
-
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
-
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.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. For 3 days followed by q8 hrs. Prn for pain.
-
Gabapentin 100 mg PO TID for one week/ Gabapentin 100 mg PO at bed time for 14
days -
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
-
Acetaminophen 1g PO q8hrs
-
Ketorolac 15-30 mg IV q6-8 hrs. Or Ibuprofen (NSAIDs) 400 mg q8 hrs
-
Gabapentin 100 mg PO TID
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
Gabapentin 100 mg PO BID for one week/ Gabapentin 100 mg PO at bed time for 14 days
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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
-
Acetaminophen 1g PO q8hrs for first week/ 1g PO Acetaminophen Q12 hrs. For second week /1g PO Acetaminophen prn for pain after second week.
-
Ibuprofen (NSAIDs) 400 mg q8 hrs. for 3 days followed by prn for pain only
-
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:
-
Gabapentin: must dose renally in kidney disease
-
Acetaminophen : contraindicated with liver disease or elevated LFTs
-
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).