| Preoperative outpatient (prior to surgery) |
| Eat a regular diet until midnight the night before surgery. |
| Drink clear fluids until two hours prior to surgery. |
| Preoperative inpatient (one hour before surgery), unless contraindicated |
| Administer acetaminophen 1000 mg orally once. |
| Administer celecoxib 400 mg orally once. |
| Administer gabapentin 600 mg orally once. |
| Apply a warming blanket 30 minutes prior to operation. |
| Intraoperative inpatient (during surgery) |
| Anesthesiology team: |
- Continue warming blanket intraoperatively.
|
- Use short-acting anesthetic agents when able.
|
- Administer prophylaxis for postoperative nausea and vomiting.
|
| |
- Minimize long-acting opioids.
|
- Administer IV ketorolac 15 to 30 mg at end of operation if patient is appropriate candidate.
|
| Surgical team: |
- Inject skin, subcutaneous tissue, and fascia with local bupivacaine or liposomal bupivacaine, as appropriate. Consider TAP block, if appropriate.
|
- Discontinue transurethral Foley catheter if appropriate at end of case (eg, no bladder injury, nonurogynecologic surgery).
|
| Postoperative inpatient |
| Wean oxygen early. |
| VTE risk assessment and thromboembolism prophylaxis: |
- First ambulation within 3 hours postoperative.
|
- Ambulate in hallway at least three times per day.
|
- Up in chair for all meals.
|
- Out of bed (walks and chair) for a total of 6 hours per day.
|
- Follow standard VTE prophylaxis regimens.
|
| Diet and fluids: |
- General diet beginning day of surgery.
|
- Maintenance intravenous fluids 1 mL/kg/hour; discontinue once patient has ingested 600 mL of oral intake or at 8 AM the day after surgery, whichever comes first.
|
- Chew sugarless gum three times per day for 15 to 30 minutes each beginning on postoperative day 0.
|
| Analgesia: |
- Acetaminophen 500 to 1000 mg orally every 6 hours for 48 hours.
|
- If NSAIDs are appropriate: Ketorolac 15 to 30 mg IV every 6 hours for 24 hours postoperatively, followed by ibuprofen 600 mg orally every 6 hours for 24 hours.
|
- If NSAIDs are not appropriate: Tramadol 50 to 100 mg orally every 6 hours as needed for pain.
|
- Oxycodone 5 mg orally every 4 hours as needed for pain score of 4 to 6 or 10 mg orally every 4 hours as needed for pain score of 7 to 10 (begin 24 hours after last intrathecal morphine dose, if applicable*).
|
- Breakthrough pain not relieved by oral oxycodone: Hydromorphone 0.2 to 0.5 mg IV; repeat once after 5 minutes if needed.
|
| Postoperative nausea and vomiting: |
- Ondansetron, prochlorperazine if needed.
|
| Bowel regimen to prevent constipation: |
- Senna 8.6 mg 1 to 2 tablets orally nightly.
|
- Docusate 100 mg orally twice a day.
|
- Other laxative (eg, magnesium hydroxide, bisacodyl, or PEG 3350 [17 g]), if needed.
|
| Bladder catheter: |
- If transurethral Foley catheter in place, perform void trial if feasible on morning of postoperative day 1.
|
