Certainly good to see this information: “The pain caused by a surgical incision may contribute to the risk of postoperative cognitive dysfunction.”
One effectively blocks incisional pain with complete NMDA receptor block; i.e. 50 mg ketamine 3-5 minutes pre-incision. Dose independent of adult body weight!
One protects the brain from negative ketamine side effects with a stable brain level of propofol easily achieved with an incremental induction (http://www.youtube.com/watch?v=GlQ3Do3b3_I) & made numerically reproducible measuring BIS <75 with baseline EMG. Using this paradigm over the past 16+ years & >3,500 patients has eliminated the need for postop opioids.
FWIW, eliminating opioids has resulted in the lowest published PONV rate (0.6%, cited in Apfel Millers PONV ch.) in a high risk group without the use of anti-emetics.