Archive Orthopedic Surgery 2018

Advances in Orthopedic Anesthesia

New ideas are emerging for managing post-op pain and enhancing recoveries.

Jim Burger

Jim Burger, Senior Editor


ON THE BLOCK Regional anesthesia continues to evolve as providers search to balance pain relief with early ambulation.

Anesthesia providers are trying to keep pace with the shift of complex orthopedic cases to outpatient ORs by looking for new ways to mitigate complications, speed recoveries and minimize — or eliminate — the need to manage post-op pain with opioids. Those efforts include more targeted and effective regional blocks, a spinal anesthetic that wears off in less than an hour and, if you can believe it, sedation-free surgery performed on wide-awake patients. Let's take a closer look at those developments and a few other trends that can help your patients bounce back faster and move around sooner after some of surgery's most painful procedures.

1. Improved pre-op preparation

Experts are beginning to realize that anesthesia, in the broader sense, shouldn't start only after the patient is wheeled into the OR.

"We're trying to be total perioperative physicians, not just intraoperative physicians," says anesthesiologist Zachary Turnbull, MD, the medical director of performance improvement and the director of the Center for Perioperative Outcomes at New York's Weill-Cornell Medical College.

Experts are reassessing the hard-and-fast rule of fasting at midnight the night before surgery. New thinking on NPO involves having patients drink carbohydrate-rich supplements 2 to 3 hours before surgery. The developing concept is a definite satisfier for patients, who show up for surgery feeling comfortable and perhaps less anxious. They're also hydrated and nourished, and a growing body of research suggests patients who don't go NPO experience fewer post-op complications and recover faster.

"You want to consider what patients are doing at home," says Dr. Turnbull. "They have better outcomes if they eat well and are well hydrated, if they're exercising a little bit, if they're training for surgery and doing the right things for their body to recover from an insult. That lets us manage the intraoperative part in such a way that we maximize the post-op period and patient outcomes."

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