ple practice reduces PONV
risk, improves IV starts and
drastically improves out-
comes.
• Frailty. Anesthesiologists
assess total joint candidates to
ensure they don't have frailty
issues that will likely hinder
their recoveries. With CMS
expected to approve knee
replacements performed in
ASCs in the near future, it will
be more important than ever
for anesthesiologists to deter-
mine frailty levels in the pre-
op consult phase.
One quick indicator: If the
patient walks with the assis-
tance of a cane, which sug-
gests preexisting muscle weakness or wasting around the joint, they may
not recover as quickly as providers would like. Another good indicator dur-
ing this phase is the "get up and go test," which involves timing how long it
takes a patient to get out of bed from a lying position and begin walking.
Superior patient education, which should include specifics on exactly
what's going to take place during the perioperative phase, is also an essential
component of any outpatient total joints program. Patients must play an
active role in their own care, and surgeons and anesthesiologists must
ensure they have realistic expectations about what the procedure will entail
and what they'll experience after surgery. Anesthesiologists can alleviate
much of the stress and anxiety patients feel simply by correcting some com-
2 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 • A U G U S T 2 0 1 9
• ONE-TWO PUNCH Combining a periarticular injection of a local anes-
thetic with an adductor canal block is an effective way to manage post-
op pain in knee replacement patients.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
