Perioperative Pain Management Protocol Builder
Design multimodal perioperative pain protocols for complex patients
What You Can Do
You can rapidly develop evidence-based perioperative pain management plans that optimize analgesia while minimizing opioid burden and adverse effects. The skill guides you through systematic assessment of patient risk factors, surgical pain trajectories, and contraindications to construct personalized multimodal strategies spanning preoperative preparation through immediate postoperative pain control.
Features
evaluate chronic pain history, opioid tolerance, substance use, and comorbidities affecting analgesic selection
integrate pharmacologic agents (opioids, NSAIDs, acetaminophen, adjuvants) with regional and neuraxial techniques
assess candidacy for peripheral nerve blocks, epidural analgesia, and infiltration strategies based on surgery type and patient factors
identify drug interactions, organ dysfunction, and patient-specific limitations that require protocol modification
structure non-opioid alternatives and adjuvant medications to reduce perioperative opioid consumption
specialized approaches for elderly, obese, sleep apnea, and neuropathic pain patients
real-time problem-solving for inadequate pain control with alternative agent or technique recommendations
templates for standardizing pain management across surgical services
Example Output
Example 1: Spine Surgery Patient with Chronic Opioid Use
- Preoperative: Continue home opioids at baseline + adjuvants (pregabalin, ketamine microdose)
- Intraoperative: High-dose remifentanil with thoracic epidural catheter placement
- Postoperative: Epidural infusion (bupivacaine + hydromorphone), multimodal non-opioid analgesics, avoid opioid escalation
Example 2: Morbidly Obese Patient with Sleep Apnea
- Preoperative: Detailed airway assessment, prepare for difficult regional access
- Regional: Ultrasound-guided peripheral nerve blocks (avoid neuraxial)
- Intraoperative: Opioid reduction, dexamethasone, local anesthetic infiltration
- Postoperative: Non-opioid focus (acetaminophen, NSAIDs if renal clearance adequate), continuous pulse oximetry, avoid sedating agents
Example 3: Major Vascular Surgery with Renal Impairment
- Pharmacokinetic adjustments: Reduce NSAID exposure, adjust gabapentin dosing
- Regional: Lumbar plexus block + sciatic block if lower extremity involvement
- Multimodal: Ketamine, dexamethasone, carefully dosed opioid with epidural component to minimize systemic load
What's Included
- SKILL.md: Core instruction file with systematic assessment framework
- Patient Complexity Checklist: Preoperative assessment tool for pain history, opioid status, comorbidities, and contraindications
- Multimodal Regimen Templates: Pre-populated protocol schemas for common surgical types (orthopedic, spine, vascular, gynecologic, thoracic)
- Regional Technique Decision Tree: Flowchart for selecting appropriate blocks, catheters, and neuraxial approaches based on surgery and patient factors
- Drug Interaction & Dosing Reference: Quick-access pharmacokinetic adjustments for renal/hepatic dysfunction, elderly patients, and polypharmacy scenarios
Who It's For
- Anesthesiologists designing complex perioperative pain plans for high-risk or chronic pain patients
- Certified Registered Nurse Anesthetists (CRNAs) managing multimodal anesthesia in regional or general settings
- Acute Pain Services developing and standardizing institutional pain management protocols
- Pain Medicine specialists consulting on perioperative cases with comorbid chronic pain
- Surgery and Orthopedic teams collaborating on evidence-based pain control strategies
Best For
- Preoperative pain assessment and multimodal strategy planning for complex surgical patients
- Designing opioid-sparing anesthesia protocols for opioid-tolerant or substance use disorder patients
- Regional and neuraxial technique selection and integration into anesthetic plans
- Managing contraindications to standard analgesics (renal/hepatic dysfunction, NSAID restrictions, allergy profiles)
- Real-time problem-solving and escalation planning for inadequate postoperative pain control
- Institutional protocol standardization and quality improvement initiatives
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