Tracy Childs, MD

(General Surgery)

ERAS Protocol for Abdominal Cases - colon resections, laparotomy, large incisional hernias

Patient is already given instructions they can drink Apple Juice and Gatorade up to 4 hours before surgery
Pre-med with acetaminophen +/-gabapentinoid +/-NSAID (note: gabapentin causes more post-op drowsiness than Lyrica/pregabalin).

3. Give less IV fluids if patient can tolerate it

4. Consider TAP block in patients – if you don’t do TAP blocks, call AIC and they will assign someone

Narcotic-Sparing Pain regimen

Surgeons write their own preoperative medications
Acetaminophen:
- Caution in patients with liver disease
- do not exceed 4g in 24 hours
- start at least 6 hours after last dose
NSAIDs
- Caution in patients with prior GI bleed or renal dysfunction
- All patients: celecoxib 400mg x1/ibuprofen 600mg x 1/naproxen 500mg x1
- Patients >65 yrs, <50kg, or CrCl 30-50 ml/min: celecoxib 200mg x1/ibuprofen 400mg x1/naproxen 250mg x1
- Creatinine >1.5, CrCl <30ml/min – no NSAID recommended
Gabapentinoids (Gabapentin & Lyrica)
- Consider lower dose or patients with OSA, age >65
- All patients: Gabapentin 300-600mg x1, Lyrica 75-150mg x 1
- Patients >65, CrCl 30-50 mL/min, h/o OSA or STOP BANG 5 or greater: Gaba 300mg, Lyrica 75mg
- Patients Cr>1.5, CrCl <30mL/min: no gabapentinoid agent recommended