Current Trends and Future Directions for Outpatient Total Joint Arthroplasty: A Review of the Anesthesia Choices and Analgesic Options

被引:6
|
作者
Osman, Brian M. [1 ]
Tieu, Tuan G. [2 ]
Caceres, Yosira Guevara [1 ]
Hernandez, Victor H. [1 ]
机构
[1] Univ Miami, Univ Miami Hlth Syst, Miller Sch Med, Perioperat Med & Pain Management, Miami, FL 33124 USA
[2] Univ Miami, Jackson Mem Hosp, Miller Sch Med, Miami, FL USA
关键词
TOTAL KNEE; PAIN MANAGEMENT; ENHANCED RECOVERY; RISK-FACTORS; HIP; COMPLICATIONS; REPLACEMENT; STAY;
D O I
10.5435/JAAOSGlobal-D-22-00259
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip arthroplasty. These surgeries are associated with increased hospital length of stay and, consequently, higher costs. Despite the benefits of outpatient surgery, only a small percentage of total joint arthroplasties (TJAs) are done in this manner. We reviewed the most up-to-date trends for outpatient TJA and discussed essential factors for a successful outpatient program, including the proper patient selection process and best available anesthetic and analgesic options, along with their risks and benefits. Risk stratification tools, such as the Outpatient Arthroplasty Risk Assessment, are helpful for predicting outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the currently recommended peripheral nerve blocks for total hip arthroplasty and total knee arthroplasty are the fascia iliaca compartment block and adductor canal block, respectively. However, blocks should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.
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页数:8
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