PCA first day is a must, with scheduled Toradol and intermittent Oxy until discharge. Even if it is not "policy" to wake a patient for a PRN, it is important to use your judgment. Talk with the patient before they fall asleep and ask them their preference. Additionally, schedule any narcotics around times you would normally enter the room (morning labs, vital sign checks, etc), as these are moments the patient will probably awake anyway. I have had amazing success by making a plan with the patient and parents prior to them falling asleep, and most end up agreeing with waking up to receive their medication, as usually, it does not produce a huge disturbance in sleep if the medication has its effect!