[Verse 1] Post-lap chole, patient's waking up, gotta build the bridge From IV to oral, structured plan, nothing left to fridge Acetaminophen scheduled, gram by gram, four times a day Celecoxib riding shotgun, inflammation kept at bay Opioids short-acting, low-dose hydrocodone PRN Seventy-two hour window, taper down and don't extend Counsel on constipation, stool softener from the gate Document the allergies, functional goals, discharge straight [Chorus] A-C-E — Assess, Construct, Evaluate your plan Cross-tolerance, rotate, reduce by twenty-five percent Taper slow when function's low, document every trend Multimodal, methodical, precision till the end A-C-E — the framework that won't bend [Verse 2] Now the kidney's failing, creatinine climbing fast Morphine-six-glucuronide accumulating — can't let that last Neurotoxicity knocking, myoclonus at the door Time to rotate agents, hydromorphone, nothing more Calculate equianalgesic — morphine sixty oral Divide by five, twelve milligrams, but hold up, read theoral Hydromorphone bioavailability shifts the math Reduce by twenty-five for cross-tolerance on the path Extended-release format? Scratch it — AKI's the wall Immediate-release dosing only, frequent intervals y'all Breakthrough at ten percent of total daily weight Reassess renal function, titrate, don't hesitate [Chorus] A-C-E — Assess, Construct, Evaluate your plan Cross-tolerance, rotate, reduce by twenty-five percent Taper slow when function's low, document every trend Multimodal, methodical, precision till the end A-C-E — the framework that won't bend [Bridge] High-dose oxycodone, no functional gain in sight Patient's been on it years, dependence wound up tight You don't cut it cold — that's a physiologic crime Ten percent reduction weekly, methodical, take your time Buprenorphine transition or slow methadone assist Behavioral health on speed dial, the psychosocial grist PDMP checked, aberrant patterns on the screen Pain specialist, social work, the whole interdisciplinary team Document the rationale, the DIRE score, the goals Informed consent for the taper, patient owns their role [Verse 3] Self-assessment time, lay the cases on the scale Discharge plan — did you anchor non-opioid first detail? Rotation — did you check the equianalgesic chart precise? Did you halve the starting dose when tolerance wasn't nice? Taper schedule — weekly drops, not daily, not a cliff Function metrics built in — pain scores alone won't shift Ask yourself what harm looks like before you sign the script Every calculation written, every rationale equipped [Chorus] A-C-E — Assess, Construct, Evaluate your plan Cross-tolerance, rotate, reduce by twenty-five percent Taper slow when function's low, document every trend Multimodal, methodical, precision till the end A-C-E — the framework that won't bend
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