Before a 7 a.m. case, I walk patients through the plan — ultrasound-guided nerve block, monitored sedation, and an airway backup — so they know we’re prioritizing safety while aiming for steady pain control. For those in anesthesiology PA roles, how do you set opioid-sparing expectations in that short pre-op window without adding stress, and do you use concrete goals like pain 3/10 or less for the first day?
I set it up with one line: “We’ll start with a nerve block and non‑opioids; opioids are backup to keep you ‘comfortable enough to take deep breaths and walk,’ not zero pain — think volume at 3–4, not cranked to 10.” If they’re on chronic opioids I flag that the target may shift a bit; do functional goals land better for you than a number?
Right before the ultrasound block, I use a 20‑second script: “block + acetaminophen/NSAID first; small opioid only if you can’t reach a ‘3–4’ that lets you cough and swing your legs,” and I flag that the block may feel heavy for 12–18 hours. @zlambert03 I also give a rescue plan — low‑dose ketamine or dex — so they know there’s a safety net. Caveat: with chronic opioid users or high anxiety, I set the target a touch higher and keep success tied to breathing and early walking.
Quick example: I tell them it’s a “pain dial, not a mute button” and show a tiny card with the rescue plan — block + scheduled acetaminophen/NSAID first, tiny opioid only if you can’t hit your usual incentive spirometer mark or dangle at the bedside. If they’re chronic opioid users, I add that we’ll cover baseline to avoid withdrawal but still spare on top; @cwhitson92, that tweak cut my day‑one opioids and PONV noticeably.
In that 7 a.m. window, I point to the ultrasound screen and say, “we’re numbing the nerves so you can breathe deep and walk sooner; woozy meds are plan B,” then set one target: “hit your spirometer mark and take a hallway lap today.” If they look tense, I add we can give a tiny IV dose if the block underperforms and hand a small card with our ERAS pathway link (https://erassociety.org) so it feels planned, not stingy. @cwhitson92 swapping number scales for that first-task goal has cut stress for me.