Table 2 Opioid-free analgesic protocol for each subspecialty and perioperative phase

PreOp

Gabapentin (PO)

300 mg (or doublecurrent up to 900)

300 mg

300 mg

300 mg

300 mg

300 mg

Tylenol (IV)

1000 mg (maysubstitute to PO ifIV Tylenol is notavailable)

1000 mg (maysubstitute to PO if IVTylenol is notavailable)

1000 mg (maysubstitute toPO if IV Tylenolis not available)

1000 mg (maysubstitute to PO if IVTylenol is not available)

1000 mg (maysubstitute to PO if IVTylenol is not available)

1000 mg (maysubstitute to POif IV Tylenol isnot available)

Meloxicam (PO)

15 mg

15 mg

15 mg

15 mg

15 mg

15 mg

Scopalamine Patch

Yes (if age < 75)

Yes (if age < 75)

Yes (if age < 75)

Yes (if age < 75)

Yes (if age < 75)

Yes (if age < 75)

Single-shot Spinal

1.5-2.0 cc 0.75%Bupivacaine(upright in OR)

IntraOp

Local Injection

0.5% Marcaineplain 5 cc

None

CERT

0.25% Marcaine plain20-30 mL (based onbody habitus)

Exparel 20 cc(suspended in 20 cc0.25% Marcaine) orCERT

None

Block

Regional Ankle Block

Brachial Plexus Block

Brachial PlexusBlock

Toradol

30 mg IV push ×1 dose (adjust forCrCl) - (given atend of sx or inPACU)

30 mg IV push × 1dose (adjust for CrCl)- (given at end of sxor in PACU)

30 mg IV push × 1 dose (adjustfor CrCl) - (givenat end of sx orin PACU)

30 mg IV push × 1 dose (adjust for CrCl)- (given at end of sx orin PACU)

30 mg IV push ×  1dose (adjust for CrCl) -(given at end of sx orin PACU)

30 mg IV push × 1 dose (adjustfor CrCl) - (givenat end of sx orin PACU)

Zofran (IV)

4 mg

4 mg

4 mg

4 mg

4 mg

4 mg

Decadron

10 mg

10 mg

10 mg

10 mg

10 mg

10 mg

PACU

Cryotherapy

Yes

Yes

Yes

Yes (q8h)

Yes

Tylenol (IV) - *up todaily maximumdose allowable perinstitution

1000 mg q6h PRN*

1000 mg q6h PRN*

1000 mg q6hr ×4doses (continuesinto postop) (maysubstitute to PO ifIV Tylenol is notavailable)

1000 mg q6h PRN*

1000 mg q6h PRN*

1000 mg q6h PRN*

Tylenol (PO) - *upto daily maximumdose allowable perinstitution

500 mg q6h PRN*

500 mg q6h PRN*

500 mg q6h PRN*

500 mg q6h PRN*

500 mg q6h PRN*

PostOp

Cryotherapy

optional

Yes (q8h)

optional

Yes (q8h)

optional

Toradol (IV)

15 mg q8h ×4doses (can beredosed to atotal of 30 mg q8h)

15 mg q8h ×5doses (can beredosed to a totalof 30 mg q8h) -available for rescue

15 mg q8h ×4 doses(can be redosed to atotal of 30 mg q8h)

Tylenol (IV) - *up todaily maximumdose allowableper institution

1000 mg q6h PRN*

1000 mg q6h PRN*

1000 mg q6hr PRN*

Tylenol (PO) - *upto daily maximumdose allowable perinstitution

500 mg q6h PRN*

500 mg q6hr PRN*

500 mg q6hr PRN*

Gabapentin

300 mg PO(or double currentup to 900)

300 mg q8h

300 mg q8h

Meloxicam

7.5 mg q24h

Decadron

10 mg (1 dose -postop day #1)

Discharge

Cryotherapy

Yes

Yes

Yes

Yes

Toradol (PO)

10 mg TID x 5d

10 mg TID x 5d

10 mg TID x 5d

Meloxicam

15 mg Q24hr × 14d

(After 5 days ofToradol) 15 mg q24hrx 28d

15 mg q24h x 28d

(After 5 days ofToradol) 15 mgq24hr x 28d

15 mg q24hr x 28d

(After 5 days ofToradol) 15 mgq24hr x 28d

Gabapentin

300 mg PO(or double currentup to 900) ×14 day(initiate wean onpatients with preopuse)

300 mg q8h × 14d

300 mg q8h × 14d

300 mg q8h ×  14d

300 mg q8h ×  14d

300 mg q8h ×  14d

Tylenol

500 mg q4h PRN

500 mg q4h PRN

325 mg q4h PRN

500 mg q4h PRN

500 mg q4h PRN

500 mg q4h PRN

ASA

81 mg BID x 28d

81 mg BID x 28d