They also started using a
liposomal bupivacaine
injection (Exparel) to help
with pain control. Together,
blocks and a local anesthet-
ic went a long way toward
making our total joints pro-
gram a success.
In terms of the surgical
process, a small change for
total-hip replacements gar-
nered big results. Most of
our same-day patients
undergo a tendon-sparing
anterior approach, which
helps mobilize patients ear-
lier and decreases their
post-op pain.
Early on, we ran into
some problems same-day
discharging patients who
experienced post-op nau-
sea or vomiting. So we ramped up our patient monitoring and changed
our protocol for patients with a history of PONV. If our same-day can-
didates had any history of PONV, we'd pre-emptively give them a
scopolamine patch. We also adjusted our algorithm for treating PONV.
Instead of treating with just 1 medication, we now have 3 potential
medications — the anticholinergic scopolamine, and antiemetics
Zofran (ondansetron) and Reglan (metoclopramide) — that we use in
a tier of first, second or third choice.
1 1 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
• TEST PATIENT Introducing an opioid-sparing protocol for our same-day
patients was so successful, we wound up rolling it out across our entire
total-joint population.
New
York
University
Langone
Orthopedic
Hospital
