[Verse 1]
Before the blade ever touches skin, we strategize the plan,
Risk stratification first — gotta understand the span,
Who's walking in with catastrophizing, anxiety, prior chronic pain?
Somatization, opioid history, psych comorbid chains,
Procedure type matters — thoracotomy versus lap chole, see the gap,
Persistent postsurgical pain probability mapped on a chart,
We score them high or low before they ever hit the cart,
PROSPECT guidelines whispering procedure-specific art
[Chorus]
Preop planning, stratify the score,
Opioid-tolerant patients need a whole lot more,
Acetaminophen and NSAIDs loaded up before,
Gabapentinoids — reappraise before you pour,
Buprenorphine continued, methadone — don't ignore,
PROSPECT tells the trajectory, set expectations at the door,
Preop planning — stratify the score
[Verse 2]
Opioid-tolerant patient rolls through registration slow,
Baseline morphine equivalents running triple digits, though,
Standard multimodal won't scratch the tolerance ceiling here,
Continue their home dose, add regional blocks crystal clear,
Methadone — keep it going, cardiac QT on the screen,
Buprenorphine partial agonist debated in between,
Some say continue full dose, some say taper down low,
2021 consensus leans toward keeping the flow
[Chorus]
Preop planning, stratify the score,
Opioid-tolerant patients need a whole lot more,
Acetaminophen and NSAIDs loaded up before,
Gabapentinoids — reappraise before you pour,
Buprenorphine continued, methadone — don't ignore,
PROSPECT tells the trajectory, set expectations at the door,
Preop planning — stratify the score
[Verse 3]
Gabapentinoids had their golden era running wild,
Every protocol stacking pregabalin profile,
But sedation, dizziness, respiratory risk piled high,
Elderly patients stumbling — now we scrutinize the why,
Reappraise — don't reflexively prescribe the standard dose,
Select the patient carefully, pick the cases where it's close,
Acetaminophen preloading — IV or oral, either track,
COX-2 selective or nonselective NSAID stacking back
[Bridge]
Patient education — the conversation surgeons skip,
Tell them where the pain curve peaks and when it'll dip,
Knee replacement hurts hardest day one through three,
Hemorrhoidectomy lingers past the week, believe,
Inguinal hernia resolves quick — here's the map,
Set the expectation or they spiral in the gap,
Catastrophizing magnifies the signal from the nerve,
Address it preoperatively — that's the curve we serve
[Chorus]
Preop planning, stratify the score,
Opioid-tolerant patients need a whole lot more,
Acetaminophen and NSAIDs loaded up before,
Gabapentinoids — reappraise before you pour,
Buprenorphine continued, methadone — don't ignore,
PROSPECT tells the trajectory, set expectations at the door,
Preop planning — stratify the score