[Verse 1] Post-op floor, patient wired to the PCA pump Demand dose dialed, lockout sixty minutes — no shortcuts Basal infusion? Careful now, that's a treacherous lane OSA patient sleeping heavy, basal amplifies the pain Of respiratory risk — so screen before you prescribe Select the right candidate, cognitively alive Can press the button, understand the concept, willing to comply Monitor sedation scores before you even say goodbye Epidural threading up the lumbar — bupivacaine low-dose Fentanyl adjuvant cutting through the visceral ghost Hypotension drops — bolus fluids, phenylephrine stands by Check anticoagulation timing or the hematoma multiplies ASRA guidelines — twelve hours off the heparin drip Twenty-four for low molecular weight before you let it rip Neurologic checks every four hours, no exceptions made Motor block assessment — if it's dense, somebody's afraid [Chorus] Cuidado, cuidado — monitora a respiração POSS score three or four — hit the Narcan, chame atenção Multimodal regime — acetaminophen, NSAID, nerve block in the game Capnografia não mente, waveform fading is a flame Cuidado, cuidado — we managing this pain Oral transition, epidural out — discharge ain't the same Descarte o opioide — lockbox, take-back, explain Cuidado, cuidado — monitora a respiração [Verse 2] POSS — Pasero Opioid-induced Sedation Scale One is drowsy, two is heavy, three means you turn pale Four is unarousable — call rapid, don't deliberate Capnography waveform flattening — intervene, don't wait High-risk population cluster: elderly, renally impaired Obese with neck circumference that's got the airway snared Concurrent benzos, gabapentin stacking sedative load These patients need continuous pulse ox down that postop road Scheduled multimodal oral — acetaminophen every six NSAID around the clock unless the creatinine conflicts Adjuvants — gabapentin, duloxetine, lidocaine patch Opioid as the rescue, not the anchor of the batch Inadequate analgesia? Reassess the source of pain Surgical complication hiding underneath the plain Constipation, nausea, itch — address each side effect clean Methylnaltrexone for the bowel, ondansetron between [Bridge] Epidural out at forty-eight, oral regimen begins Transition overlapping — don't abandon patients thin On coverage — bridge with short-acting, titrate to effect Calculate the prior IV morphine equivalent, reflect Then convert to extended-release with a twenty-five percent Reduction for cross-tolerance — that's the safety argument [Verse 3] Discharge day — don't hand a script without the education Lowest effective dose, shortest duration, no deviation Disposal matters — DEA take-back, activated charcoal pouch Lock the medication, keep it out of reach inside the house Counsel every patient — don't share, don't crush, don't snort Document the conversation, that's your medicolegal fort
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