Tracy Childs, MD

(General Surgery)

(310) 991-3875

 

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

  1. Patient is already given instructions they can drink Apple Juice and Gatorade up to 4 hours before surgery

  2. Pre-med with acetaminophen +/-gabapentinoid +/-NSAID (note: gabapentin causes more post-op drowsiness than Lyrica/pregabalin).  No Gapapentinoid with duramorph

  3. Do a spinal with DUROMORPH (unless contraindicated, see dosing suggestion) – put in order set “Anesthesia Neuraxial Single dose” when you do this procedure. This will include orders for continuous pulse oximetry as well as medications for respiratory depression and pruritus

Intrathecal Morphine Dose by Age

  < 50: 0.3 mg

50-59: 0.2 mg

60-69: 0.15 mg

70-79: 0.10 mg

  > 80: not routinely recommended, use judgement

4.   Give less IV fluids if patient can tolerate it

5.   Consider TAP block in patients who are not a candidate for spinal– 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, or neuroaxial opioids

    • 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 

    • Do no use in combination with Duramorph Spinal

PHONE: 310-829-8202  

Mon - Fri 11:00am - 7:00pm

After Hours Please Call: (310) 341-7655

 

FAX: 310-829-8209

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