patients must be up and moving as quickly as possible.
There are no clear complications associated with general anesthesia,
although neuraxial anesthesia avoids the potential adverse effects — car-
diopulmonary depression and residual muscle paralysis — associated with
the drugs used to administer it. Still, general anesthesia is a better choice for
outpatient total joints than spinal, which could delay post-op ambulation and
discharge due to muscle weakness and postural hypotension.
PONV is a complication that anesthesiologists tackle with prophylactic
multimodal antiemetic therapy. The combination of antiemetics depends on
the patient's risk level. For example, a combination of IV dexamethasone 8
mg and ondansetron 4 mg works for most patients, but those at a very high
risk of PONV may require additional antiemetics such as a preoperative
transdermal scopolamine patch.
Intraoperative bleeding is controlled through the use of tranexamic acid
(TXA), an antifibrinolytic agent that minimizes blood loss and the need for
transfusions, both critical components of performing total joints in the out-
patient setting. Common dosing (though there is variability) is 1 gm IV
before incision followed by 1 gm at the end of surgery.
3. Pain management
Of course, post-op pain is the ultimate litmus test for the success of total
joints anesthesia. In the era of the nationwide opioid crisis, managing
pain with limited opioid use should be a top priority. But keep in mind
there's a big difference between "opioid-sparing" and "opioid-free" sur-
gery. The latter has no place in total joint procedures; opioids have to
play some part in the patient's recovery, although anesthesiologists must
limit their use as much as possible. Aggressive multimodal analgesia
combined with regional blocks is one of the most effective ways to do
that.
A combination of non-opioid analgesics that includes acetaminophen
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