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the day of surgery and typically do what it takes to make it happen. • Multimodal analgesia. Patients receive acetaminophen, an anti- inflammatory agent and low-dose gabapentin for calming nerves as soon as they reach pre-op. Before the surgery, an anesthesia provider administers a short-acting spinal block, which numbs the lower extremities for enough time for us to operate at a comfortable pace. Patients receive twilight sedation during surgery and rarely need gen- eral anesthesia. That means they typically awake clear-headed, ready to walk, hungry and feeling remarkably good, considering the proce- dure they just underwent. Mobilizing patients as quickly as possible speeds their recoveries, so we often rely on a simple regimen of ice on the surgical site and doses of acetaminophen to manage post-op pain. We avoid the use of opioids whenever possible in order to keep patients alert and nau- sea-free, but they are available as a last option if a patient's discom- fort becomes unbearable. • Anterior approach. The anterior approach is the shortest and least disruptive way to reach the hip. It also spares the major muscles and ligaments of the hip, so there's less muscle and soft tissue to fix after the joint is replaced, which is one of the main reasons patients can ambulate soon after surgery and prepare for same-day discharge. Another significant advantage of the anterior approach: You can place patients in the supine position during surgery. Because patients are lying flat on their backs, anesthesia providers and surgeons are more comfortable performing the procedure using spinal anesthesia and without having to intubate. Most traditional hip replacement sur- geries are done with patients on their sides, which makes it difficult to establish the airway in emergent situations. With the anterior approach, the anesthesia provider doesn't have to give the patient as much medication preemptively to secure the airway, and that means 9 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 • S E P T E M B E R 2 0 1 6