Maine Medical Center
Department of Anesthesiology and Pain Management
J. Pisini May 2014
Patient Identifiers for Post Operative
- Post operative pain problems:
Anxiety: significant anxiety or PTSD treated with
Pain: preexisting pain and/or
chronic pain treated with chronic opioids for greater than 3 months.
History of chronic
pain associated with Crohn’s disease or Colitis
Prior history of post operative pain problems.
- Post operative nausea and vomiting:
Prior history of post operative nausea and vomiting.
- Once these patients have been identified through
PREP, a new FYI flag “Postop Pain Risk” should be created. PREP may alert APMS for development
of peri operative plan.
- Patient alerts for the OR status boards are a
yellow triangle with an exclamation point in the middle. If you hover over icon, the FYI
flags will appear.
- Patient education.
- Strongly consider Neuraxial or Regional analgesia
to assist with post operative pain
- Single shot femoral nerve block is standard for
TKA. Consider addition of
sciatic nerve block and/or placement of femoral nerve catheter.
- Ketamine bolus intraoperatively; usually start ketamine
infusion intra-op and continue postoperatively for 48 hours. (See Ketamine
as an Adjunct to Pain Management:
A Clinical Practice Guideline)
- Post op addition of IV Ketorolac, if not
- Post op addition of IV Acetaminophen (Ofirmev).
- Post op addition of scheduled Zofran
- If inpatient and/or not seen at PREP,
preoperative evaluation would include the above criteria.
- Transition to PO analgesics
- Preventing pain cliff
- Keeping IV PCA for breakthrough pain during
transition to PO analgesics
- Alert Physical Therapy if Peripheral Nerve
Catheter in place (or additional block utilized)