Perioperative

Gabapentin, 600 mg, oral

Celecoxib, 400 mg, oral

Acetaminophen, 1,000 mg, oral

Clonidine transdermal patch, 0.1 mg every 72 hour

Dexamethasone, 8 mg, intravenous

Methadone, 0.2–0.35 mg/kg, intravenous

General anesthesia (induction)

Fentanyl, 0.5–2 mcg/kg; lidocaine, 1–2 mg/kg; propofol, 2–4 mg/kg; intravenous

Postoperative day 0

Patient-controlled analgesia (PCA), 0.2 mg intravenous at 8-min demand interval dosing with a 4.8-mg lockout at 4 hour (increase in on-demand dosing up to 0.4 mg allowed if necessary for a pain level consistently above 4). PCA initiated in the recovery room and maintained with demand dosing only

Ketorolac, 30 mg, every 8 hour, intravenous

Gabapentin, 300 mg every 8 hour, oral

Acetaminophen, 1,000 mg every 6 hour, × 4 doses intravenous, then oral

Clonidine transdermal patch, 0.1 mg every 72 hour

Postoperative day 1 to discharge

PCA discontinued the morning of postoperative day 1; OxyContin started, 10–20 mg every 12 hour, oral, continued

Oxycodone, 5–10 mg every 3–4 hour as needed, oral, continued

Ketorolac discontinued; ibuprofen started, 600 mg every 8 hour, oral, continued

Gabapentin, 300 mg every 8 hour, oral, continued

Acetaminophen, 1,000 mg every 6 hour, oral, continued

Clonidine transdermal patch, 0.1 mg every 72 hour, continued