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

From: Study protocol: randomized controlled trial of opioid-free vs. traditional perioperative analgesia in elective orthopedic surgery

   Spine (ACDF/ACDA) Foot&Ankle (HalluxValgus/Rigidus) Hip (THA) Knee (Knee Scope) Shoulder (TSA/RTSA) Hand (1st CMCarthroplasty)
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  
  1. * indicates dosing up to daily maximum allowed