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O R T H O P E D I C S
recover quickly.
We give patients epidural nerve blocks with propofol sedation. We
focus on administering as little sedation as possible, which means
patients might move slightly during surgery, making the procedure
more difficult for surgeons. They have a couple of choices when that
happens: Tell the anesthesia provider to administer more sedatives,
which increases PONV and post-op complication risks and jeopardizes speedy recoveries and timely discharges; or tolerate the patients'
movements to minimize giving intraoperative medications and to
increase the likelihood of timely discharges.
To further help control PONV, we give patients 4mg prophylactic
doses of ondansetron at the time of surgery. We also avoid using all IV
intramuscular narcotics and don't put narcotics in epidural nerve
blocks. Patients who receive narcotics are given oral doses, which can
cause nausea, but the risk is much less than with IV formulas. We give
patients who do become nauseated less pain medication, fluid boluses
or doses of the antiemetic metoclopramide.
• DVT. Deep vein thrombosis and pulmonary emboli are always concerns and potential complications we take very seriously.
Administering epidural nerve blocks instead of general anesthesia
helps alleviate the risks. More importantly, patients are up and walking
soon after surgery, which gets blood flowing in the legs. Lastly, we use
chemical prophylaxis. Most patients take aspirin twice daily for a few
weeks. We give patients with very high risk factors for DVT warfarin or
low-molecular-weight heparin.
Don't assume that patients recover easily and are ready for discharge with just a few tweaks of their medications. Success in outpatient knee replacement demands constant monitoring and titration of
doses based on an individual's medical history and current condition.
J U N E 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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