Position: Supine, Trendelenburg, arms tucked
Time: 1-2 hours (average)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: High (7-10)
Maintenance Paralytic: Yes

Blocks: TAP

Approach – GETT. Bilateral TAP blocks are recommended after induction.

Hydrate – Bowel prep will be done on these patients so the will be dry with potential electrolyte abnormalities.

High Post-op Pain – Post-operative abdominal pain levels are high, which can impair breathing. Bilateral TAP blocks will help tremendously. If blocks are not possible, do your best to treat pain before wakeup. Watch for signs of hypoxia/hypercarbia.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

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High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.