Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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4 0 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 2 0 anesthesia. Spinal anesthesia in general results in fewer complications than general anesthesia. There are newer modes of general anesthesia, such as total intravenous anesthesia, that could result in improved outcomes. Local infiltration analgesia used by surgeons intraoperatively in and around the joint provides six to 12 hours of pain relief after total knee arthroplasties, but has no analgesic effect with total hip arthroplasties. Active patient warming has proven to be the best way to adhere to the ERAS protocol for maintaining normothermia. Heat loss in patients during surgery causes an increased stress response, and can cause infections and cardiovascular complications. Optimal intraoperative fluid balance should be maintained. Anemic patients should be treated pre- operatively with iron supplements or erythropoi- etin. Hypotensive anesthesia techniques can be used to minimize blood loss. Tranexamic acid given orally, intravenously or topically in the joint space can reduce the need for transfusions. • In recovery and beyond. Enhancing postopera- tive comfort is a key element of orthopedic ERAS, but can be challenging because of the pain involved after the procedures. Acetaminophen, NSAIDs, gabapentin and ketamine have all been used for this purpose, but essentially reduce dis- comfort while falling short of eliminating pain. Fortunately, ultrasound-guided continuous nerve blocks have revolutionized post-op pain relief. They're precise and provide targeted analgesia for up to three or four days. Preventing postoperative nausea and vomiting (PONV) is best achieved by completely avoiding general anesthesia and opioids. Patients with increased risk factors for PONV should receive dex- amethasone at the induction or the end of the pro- cedure, a serotonin receptor antagonist at the pro- cedure's end — or both. Early mobilization and rehabilitation are key Be"er opioid-sparing results. Extend analgesia up to 5 days to avoid POD3 or 4 rebound pain that can trigger post-op opioid need, unplanned readmissions. Be"er infusion management. Nimbus PainPRO pump Delay Start begins the infusion as your intra-op block is receding at 2AM. Be"er patient outcome. IntermiHent Bolus capability in Nimbus PainPRO enhances anesthetic spread achieving results your elastomeric pain pump can't touch. You and your patient want opioid-sparing recovery. That's why: We make pain pumps. Better. Get be"er with Nimbus PainPRO pump: www.nimbuspainpro.com or call +1 (844)-479-8500.