Fast-Track Microdisectomy Guidelines

Updated May 8, 2014
Author:  Pisini / McKinley / S. Carter

Description: Management guidelines for Fast-Track Intra-Op and Post-Op care of certain patients have micro-discectomy

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Contents


Intra-Op Anesthesia:

  1. Midazolam IV as needed
  2. Propofol induction with maintenance of Sevoflurane
  3. Ofirmev® (parenteral acetominophen) 1gm IV if not given pre-op
  4. Ketorolac 30mg IV if no contraindications
  5. Fentanyl IV as needed
  6. Dexamethasone and Ondansetron for antiemetics
  7. Maximum infiltration with local anesthetic by surgeon

Phase I Recovery Pain Management:

  1. Fentanyl IV as needed for pain control
  2. PO analgesics as soon as tolerated (usually within the first 30 minutes with crackers)
  3. Ofirmev® (parenteral acetominophen) 1gm IV if not given pre-op or intra-op
  4. Morphine or Hydromorphone for inadequate pain relief (these orders will most likely not be included in the PACU post-op orders; contact anesthesia staff if needed
  5. Haloperidol is the anti-emetic of choice for Phase I Recovery

Phase II Recovery:

  1. Goal: Patient will get up to the chair within 45 minutes
  2. Goal: Patient will be ambulatory within 60-90 minutes
  3. Neurosurgical PA will evaluate the patient and ensure necessary orders are entered for discharge
  4. Encourage PO fluid intake
  5. Patient is required to void prior to discharge

References:

  1. UCLA Spine Center Video