1 2 S U P P L E M E N T T O 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 A U G U S T 2 0 1 5
fashion. The typical case lasts about an hour, and I've been able to do as many
as 8 procedures in a single day. We try to have all joints done by 2 p.m. and want
all patients discharged to home by 7 p.m. at the latest.
To reduce the risk of infection, we give patients antibiotic soap to shower
with for 2 days before the day of surgery. We also give them IV antibiotics an
hour before surgery and use chlorhexidine wipes in pre-op. Later, we put a gram
of vancomycin powder in the wound as we close.
All nerve blocks are done in pre-op (for knees, we use an adductor canal
block). That's crucial. The OR is strictly for surgery. We make sure our anesthe-
sia providers have their own space and don't feel pressured by surgeons. It's
their turf and they have nurses dedicated to helping them draw medications and
place blocks. A mastery of ultrasound is extremely important and our anesthe-
sia providers are gifted when it comes to using it.
Once the regional
blocks are placed, we
whisk patients into the
OR, where the surgeon,
an anesthesia provider,
a PA and an RN circula-
tor await. Ideally, the
surgeon is alternating
between 2 ORs and can
move between them as
the PA closes and the
staff turns over the
room. That's our stan-
dard protocol, and it
also requires a helper
who goes between the
2 rooms, taking care of
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