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Mailing Address: Division of Gastrointestinal & Bariatric Surgery 420 Delaware Street SE, MMC 195 Minneapolis, MN 55455 Office: 612-626-6666 Fax: 612-625-3206 Dear Pain Clinic Provider: Thank you for taking the time to see our mutual patient for clearance from a pain management perspective prior to bariatric surgery. Please assist us with the following during your evaluation of our mutual patient: • Provide a letter stating that the patient is cleared to proceed with bariatric surgery from a pain management standpoint. • Provide any recommendations for pre-surgery (if any), and after surgery (if it varies from our protocol below). • Guide and facilitate follow-up treatment beyond the 30 days post op period. If you have any questions, contact Barbara Sampson, RN, Nurse Coordinator, at phone #: 612-625-1124 or pager: 612-899-1106. Please fax the letter to 612-625-3206. Sincerely, Dr. Sayeed Ikramuddin; Dr. Daniel Leslie; Kristi Kopacz, PA-C Weight Loss Surgery Center University of Minnesota HEALTH www.umnwls.org Weight Loss Surgery Pain Medication Protocol: 1. After Bariatric surgery patients will generally be sent home with a prescription for Roxicet elixir 150-200 cc (equivalent to 30-40 Percocet). 2. Primary laparoscopic bariatric surgery patients should expect to require narcotic pain meds for a few days to a week. After the first few days pain medications can be decreased and transitioned to Tylenol if needed. No non-steroidal medications such as ibuprofen, naproxen, Motrin, Aleve, Advil etc. should be used. 3. We do not prescribe pain medications beyond 30 days post op for standard post-op pain. 4. If a pain medication refill is needed, a clinic visit will be required. Narcotic prescriptions cannot be called into pharmacies. 5. If patient requires pain medication before surgery they will need to have a clear plan from their pain treating provider for pain management after their surgery. We will ask that their provider manage all narcotic pain prescriptions after the immediate post op period.