Routine use of opioids?

IMHO, I think it should be given before surgery for an amputation, except when the amp is due to vascular disease. Since I don't work PACU I can't answer but from a personal standpoint I think it's a good idea.
In veterinary medicine, some vets will give pain meds before the end of surgery. I think when you're expecting pain, give it.

I give narcotics intra-operatively to all my patients who receive a general anesthetic. I use Sufenta up front and then give Dilaudid or Morphine towards the end of the case to help with post-op pain. I also use a lot of Ketamine to supplement their pain relief. I know that all of my collegues practice similar techniques and that we all give narcotics during a case. If a patient gets a regional ie...SAB or epidural, I still use narcotics, though in smaller doses. This helps them keep comfortable while lying still during the case.
I'm interested in why you asked.

I cant imagine any anesthesia provider not giving opioids during a case especially when it is a case known to have high postoperative pain.. I cant think of a case were I have not given opioids outside of strictly a regional technique.

Sharann-

Remember there is no routine/ cookie cutter style to an anesthetic...it is patient / procedure dependent. It is not absolutely necessary to give a patient opioids because they are getting a general anesthetic. I give opioids if I anticipate that a patient will have pain or an elevated adrenergic response to airway manipulation probably 99 % of the time, it is by no means mandatory if I think the opioids will be detrimental to them. I will admit to you, there are times when I heavily depend upon our PACU staff to play catch up with a patients comfort in exchange for a safe emergence for the patient. Unfortunately, we have not yet perfected analgesics to allow us to give them indiscriminantly...including ketorolac and non opioids.

I do understand where you are coming from, I had an attending or two that were very anti-narcotic in school, and any time I asked them why, they were very happy to give their rationale. Maybe you should discuss this with the anesthesia providers before you plan on writing them up (a nice pacifier that will get you nowhere), or talk to the chief of the anesthesia group if they don't listen. Also take into consideration that the best thing for your patients continuum of care will be a trusting relationship between you and the anesthesia providers...so you need to protect this as well.

Just some insight from my perspective, good luck.

There are a few general cases that I may try not to use narcs if they are planning to discharge quickly and its not typically a very painful procedure. One example is knee arthroscopy, I give toradol up front and the surgeon injects well with with local, and I have a comfy pt. waking up.
We also have a few attendings who are anti-narcotic, and I agree with zrmorgan that you should ask their rationale. "Writing up" an anesthesia provider is likely to go into the circular file. I suggest speaking to the offender directly or talking to the director of the anesthesia department regarding your concerns.
Personally, I love dilaudid, and give narcotic when necessary, but as a previous poster stated, the patients health, body habitus, airway status, etc., all play into our decision-making regaring the amount and timing of narcotics given, things PACU staff may not be aware of. Keep us posted.

It sounds like you will have to involve the Chief of Staff, Chief Surgeon, maybe the Board of Trustees, who knows?

I applaud your courage and your concern for your patients. I hope ALL of your colleagues will stand with you. Otherwise, you risk going down. Are the patients suffering enough for you to take that risk? If not, just take care of them the best you can and be quiet. Pray for the day this doctor will, himself, experience severe unnecessary pain. Then, maybe he'll understand.

Has your boss or anyone else ever talked to him?