Ambulatory General Surgery CarePath   Laparoscopic Open Goals Reduce PACU length of stay and increase patient satisfaction by reducing post-op pain, PONV, and sedation by minimizing opioids and incorporating a multimodal analgesic regimen. To whom it applies Laparoscpic cholecystectomy Lap inguinal hernia Lap ventral hernia Open inguinal hernia Umbilical hernia Anorectal surgery Access Port placement and removal. Medications Please check for allergies, contraindications and appropriateness of medications for all patients before ordering. Meds ordered night before Pregabalin 75mg PO x 1. Acetaminophen 1000mg PO x 1 No Gabapentinoids routinely Consider a holding area huddle: Huddle between surgical, anesthesia teams and the patient to discuss: PO meds administered in holding area. Prescriptions that the patient will take home (so that PACU orders can be coordinated). Blocks Usually no blocks indicated All cases that need a block will be booked as such ( if not booked as a block ,surgeon will infiltrate locally) Type of Anesthesia General General or MAC depending on patient and complexity. Induction Dexamethasone 8mg IV SLOW Dexamethasone 4mg IV SLOW except for the anal condyloma and dysplasia cases Surgeon Surgeon to instill local anesthetic at the port sites in laparoscopic at placement and again on removal. Surgeon to instill local anesthetic into wound if no block has been placed. Intraop Consider Ketorolac 30-60 mins before the end of the case Ondansetron 4mg IV at end of case. Minimize IV fluids <1200 ml Minimal opioids. Short acting (Fentanyl or Dilaudid in low doses). Voiding Voiding requirements only for inguinal hernia surgery with any of the following risk factors. Patient will follow the voiding protocol if they have to demonstrate voiding before discharge. Pts with h/o urinary retention H/o BPH Fluid administration >1200 ml for the case and age >65 PACU PO Opioid as needed when able to tolerate PO. IV opioid (fentanyl or hydromorphone in low doses) for breakthrough pain, if unable to tolerate PO, or VAS>5. IV opioid (fentanyl or hydromorphone in low doses) for breakthrough pain, unable to tolerate PO, or VAS>5 Authors Dana Fugelso M.D, Michael Cahalane M.D, Peter Mowschenson M.D, Sowmya Mahapatra M.D, Irina Fishman M.D, Susan Dorion RN BSN MSN , Eswar Sundar M.D, Cullen Jackson Ph.D., Pete Panzica M.D, Meghan Connolly RN, BSN, ACNP, Mary Ellis RN BSN, Marianne McAuliffe RN, BSN, Kathleen Mulligan RN, BSN, Elena Canacari RN, John Tumolo,