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Fluid, pain and nausea management may lead to rapid rehabilitation after TJA
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ORLANDO, Fla. — Rapid rehabilitation may be possible by appropriately managing fluids, pain and nausea in patients undergoing total joint arthroplasty, according to a presenter here.
In his presentation, Mark W. Pagnano, MD, noted surgeons should encourage patients to drink clear liquids up to 2 hours before surgery, as patients who are well hydrated have a more predictable response to anesthetic agents, as well as show a lower risk for hypotension, nausea and pain. He said more liquids may also help minimize blood loss and the need for transfusions.
“The clinical symptoms that you and I have traditionally attributed to anemia are most often a volume problem, not a red blood cell problem, and most patients can tolerate hemoglobin of 8 or even slightly lower,” Pagnano said in his presentation. “Instead, think fluid first, red blood cells only later and those traditional indicators of a need for transfusion — orthostatic hypotension, elevated heart rate [and] low urine output — almost always respond to IV fluids and rarely require a transfusion.”
When it comes to pain management, he said “patients now are best served with a series of preoperative medications followed by postoperative medications on a schedule.”
Pagnano recommended the use of spinal anesthesia over general anesthesia for faster recovery, and said surgeons should consider IV anesthesia for patients who require general anesthesia.
“Finally, we want to get ahead and stay ahead of nausea. Promote fluids and be proactive with your nausea screening,” Pagnano said. “Most patients that are high risk are best served by getting some IV steroids and then some additional medication to address the nausea.” – by Casey Tingle
Reference:
Pagnano MW. Paper #8. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.
Disclosure: Pagnano reports he receives institutional research support at Mayo Clinic from multiple orthopedic companies and has individual product development agreements with DePuy Synthes and Stryker.