X-ray processing machine or a C-arm, which can be both expensive
and difficult to store. Your center should decide whether the invest-
ment is cost-effective for your facility. Templating orthopedic proce-
dures will save you an enormous amount of time in the OR, as you'll
know the right implant — often within 2 mm of the implant you end
up using — and where to make your cuts
3
Non-opioid pain control
Managing a patient's pain is a huge part of making your total
hip procedures more efficient, especially in an outpatient set-
ting. The less pain a patient feels following a surgery, the more ready
he is to return home within hours.
However, I try to avoid opioids like hydrocodone and oxycodone
and instead give my patients tramadol for breakthrough pain. I've
found that opioids are not entirely necessary for hip replacements,
and that tramadol acts as a more moderate, non-narcotic pain reliever.
For my practice, pain management starts in the office when I meet
with patients for a consultation day around 2 to 3 months before their
procedures. I ask each total hip patient what medications he's current-
ly taking for pain, to rank his pain on a 1-10 scale and I ask whether
his medication helps reduce that pain. Those simple pre-operative
questions can give you a strong sense of how to handle your patient's
pain following the procedure.
For example, if a patient ranks his hip pain as a 7 and says that
ibuprofen controls that pain, I'll suggest he continue taking ibuprofen
— rather than a prescription painkiller — following the procedure.
I've found that whatever the patient takes for his hip pain before the
operation generally controls his post-op pain as well.
On the day of surgery, we give patients several preemptive pain
medications, including 1 g of acetaminophen and 400 mg of celecoxib,
8 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R U Y 2 0 1 8
