[Verse 1]
Step into the OR, got a strategy to frame,
Opioid-sparing anesthesia, we changing up the game,
Remifentanil's quick but leave a paradox behind,
Hyperalgesia creeping in, sensitizing every spine,
The mu-receptor floods and then the rebound pain ascends,
So we blunt that NMDA storm before the case even ends,
Ketamine's the sentinel, sub-anesthetic dose,
Blocking wind-up pathways, keeping nociception close,
Systemic lidocaine dripping through the line with grace,
Anti-inflammatory, cutting ileus out the place,
Dexmedetomidine riding on the alpha-two receptor site,
Sedation without suppression, keeping breathing tight,
Magnesium chelates calcium, stabilizing every nerve,
Adjuvants stacking synergy — that's the protocol we serve
[Chorus]
K-L-D-M, remember every name,
Ketamine, Lidocaine, Dex, Magnesium — tame the pain,
Opioid-sparing, neuraxial maintaining,
ERAS components, multimodal reigning,
Wound infiltration, surgeon blocking the plane,
TAP and rectus sheath cutting through the strain,
K-L-D-M, carve it in your brain,
Adjuvants plus regional — that's how we contain
[Verse 2]
Now pivot to the neuraxial, epidural in the space,
Thoracic level threading, putting opioids in their place,
ERAS protocols demanding we reduce systemic load,
Spinal plus intrathecal morphine walking down that road,
Peripheral nerve blocks flanking like a tactical brigade,
Bupivacaine or ropivacaine, the long-acting cascade,
Continuous catheter infusions holding postop pain,
Cutting through the cortisol, abolishing the strain,
Attenuate the surgical stress response at the source,
Blunt that sympathetic surge and steady up the course,
Regional techniques aren't supplemental, they're the core,
Neuraxial analgesia is what ERAS protocols adore
[Bridge]
Here's a word — nociceptive plethora — a stunning surplus of pain signals flooding gates,
We don't overwhelm the system, we anticipate those states,
Preemptive, multimodal, every layer checked,
The anesthesiologist as architect
[Verse 3]
Surgeon steps in close, the case is almost done,
Wound infiltration laid before the closure's begun,
Long-acting local, bupivacaine beneath the fascia plane,
Soaking nerve endings before the patient wakes to rain,
TAP block — transversus abdominis plane — the surgeon maps the wall,
Between internal oblique and transversus, catching nerves that crawl,
T-seven down to twelve, the somatic fibers trapped,
Rectus sheath block threading midline, ventral coverage unwrapped,
Surgeon-administered blocks democratize the skill,
No anesthesiologist required — the team can fit the bill,
Infiltration, TAP, rectus sheath in concert sealed,
Opioids retreating from the postoperative field