Table 1.

Perioperative multimodal pain regimen

Preoperative

Acetaminophen 1 g 2 h before surgery

Gabapentin 300 mg 2 h before surgery

Intraoperative

Recommend reduced opioid use to < 500 μg fentanyl

Local anesthetic with liposomal bupivacaine 10 mL chest tube sites 15 mL incision

Postoperative

Dexmedetomidine (initiated in OR, continued until extubation)

Acetaminophen 650 mg scheduled every 6 h

Lidocaine 5% transdermal patch, applied to bilateral back or chest

Gabapentin 100 mg TID 100 mg BID if renal impairment

Tramadol 50-100 mg PO every 6 h-PRN for mild pain (every 12 h for CrCl <30, max 200 mg/d)

Oxycodone 5-10 mg PO every 4 h-PRN moderate pain

IV opioids (eg, hydromorphone, fentanyl), PRN severe/breakthrough pain Dose and drug at provider discretion Discontinued when chest tubes removed

OR, Operating room; TID, ter in die (3 times daily); BID, bis in die (2 times daily); PO, per os (by mouth); PRN, pro re nata (as needed); CrCl, creatinine clearance; IV, intravenous.