Pre-op

Intra-op

Consider GA = can be difficult for patient to lie supine for 1.5 hours

• Spinal
• LMA
• P 2.0-3.0
  • Will need higher Ce as the spinal wears off
• Entropy

spinal #1

• 4 mL 0.5% heavy bupivacaine
• 100 mcg morphine
• can add 30 - 50 mcg clonidine
• sit up for 15 minutes
• reverse Trendelenburg
• have metaraminol infusion started

spinal #2

• 3 mL plain 0.5% bupivacaine
• 20 mcg fentanyl = 0.4 mL
• 100 mcg morphine =

propofol TCI 2.5-3

midazolam 1-5 mg

LMA + GA

Technique

• Spinal 2.4 mL heavy + F15 + M100
• Adductor canal catheter
• LMA because supine and AW obstruction
• TAX

Post-op

Long-acting opioid

• Targin 10/5 BD
• tapentadol SR 50 mg BD

Short-acting opioid PRN

• Tapentadol 50mg QID PRN
• Endone 5-10 mg Q3H (has a shorter dose interval than tapentadol)

Paracetamol 1g QID

NSAID

• celecoxib 200 mg BD
• reduce dose to 100 mg BD for
  • elderly = 70+
  • low body weight