Perioperative solutions for rapid recovery joint arthroplasty: get ahead and stay ahead.

Abstract

Rapid recovery after total joint arthroplasty requires patients to get ahead and stay ahead or the four impediments to early rehabilitation and discharge: volume depletion, blood loss, pain, and nausea. Adequate volume resuscitation starts before entering the operating room and focuses on intravenous fluids rather than red blood cell transfusion. Tranexamic acid limits blood loss and reduces the need for most other blood management systems. Rapid recovery pain management focuses on minimizing parenteral opioids. A short-acting spinal with a peri-articular local anesthetic injection is reliable, reproducible, and safe. Patients at risk for post-operative nausea are treated with anti-emetic medications and perioperative dexamethasone. These interventions reflect a transition from the sick-patient model to the well-patient model and make rapid recovery joint arthroplasty a reality in 2015.

• Authors: Peter K Sculco, Mark W Pagnano
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 30 Issue 4 Pg. 518-20 (Apr 2015) ISSN: 1532-8406 [Electronic] United States
• PMID: 25680452 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Antifibrinolytic Agents
• Tranexamic Acid

Topics

• Antifibrinolytic Agents (therapeutic use)
• Arthroplasty, Replacement (adverse effects, rehabilitation)
• Clinical Protocols
• Fluid Therapy
• Hemorrhage (etiology, therapy)
• Humans
• Pain, Postoperative (etiology, therapy)
• Perioperative Care
• Postoperative Nausea and Vomiting (etiology, therapy)
• Tranexamic Acid (therapeutic use)
• Water-Electrolyte Imbalance (etiology, therapy)