PCA Orders and APS Consult

Hydromorphone PCA (provide demand only if the patient received methadone or IT morphine)

• Start in PACU & to be discontinued on POD 1

Ketorolac IV 0.5 mg/kg (Max 15 mg) q6 hrs scheduled

• Alternate with acetaminophen q3 hrs
• Transition to PO ibuprofen 10 mg/kg (Max 800 mg) q6 hrs on POD 1

Acetaminophen IV 12.5 mg/kg (Max 750 mg) q6 hrs

• Transition to PO acetaminophen 12.5 mg/kg (Max 750 mg) q6 hrs on POD 1

Diazepam IV or PO 0.05-0.1 mg/kg (Max 5 mg) q 4-6 hrs PRN or scheduled

If poor pain trajectory is anticipated or if pain escalation is required, may consider the addition of the following:

• Low-dose ketamine infusion
• Dexmedetomidine infusion or clonidine IV dosing followed by patch placement
• Other pain adjuncts as needed
  
  

Surgery to order Dexamethasone IV 0.1 mg/kg (Max 8 mg) q8 hrs x 3 doses

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.