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Enhanced Recovery Programme

Enhanced Recovery Programme. K J Drabu Consultant Orthopaedic Surgeon. Aim. Improve patient care and experience Good analgesia Minimal GI problems Minimal complications (Surgical & General) Early discharge Good mobility . Where does it start and where does it go?. Patient GP

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Enhanced Recovery Programme

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  1. Enhanced Recovery Programme K J Drabu Consultant Orthopaedic Surgeon

  2. Aim Improve patient care and experience Good analgesia Minimal GI problems Minimal complications (Surgical & General) Early discharge Good mobility

  3. Where does it start and where does it go? • Patient • GP • Pre-assessment – Physio and nurse • Surgeon/Anaesthetist • Ward staff • Patient

  4. Philosophy • Positive approach from the start • Patient and home support team pre-prepared • Clear understanding of the whole process • Emphasis on early and safe mobility • Encourage the patient to “lead”

  5. Patient • Aware and requesting the procedure • Word of mouth and media • Defined admission date and defined discharge date • Home support in place when needed

  6. GP • Aware of the process • Pre-prepares patient for process – Co-morbidities, smoking, bowels etc • Pre-prepares home support • NOT RAPID DISCHARGE

  7. Pre-assessment – Physio and Nurse input • Positive approach • Point of contact for patient • Deal with any issues – Pain, smoking, bowels etc • Prepare for appropriate mobility • Pre-op exercise programme

  8. Anaesthetic • Single shot spinal • Propofol • Tranexamic acid and intra-operative re-transfusion • IV Abx • Ondansetron • IV Fluids to 1 Lit intra-op

  9. Operative Technique Standard procedure • A/lat approach, supine • Mini-incision • Preservation of Glut Medius Obese patients • Posterior approach TO DRAIN OR NOT TO DRAIN??

  10. Mini Incision • 2 cms greater than cup • 10 cms or less • Minimal disturbance to soft tissues • Berger – Chicago (Dual incision) • AMIS

  11. Mini- Incision THRs Advantages • Less soft tissue disruption • Quicker rehabilitation • Less blood loss Disadvantages • Less visualisation • Risk of complications

  12. Indications for Mini Incision THRs • Not overweight patient • Good bone • “Normal” arthritic hip joint • Not bilaterals? • 95%

  13. Antero-lateral approach • Preserve Glut Medius • Leg length • Cup orientation • Stability

  14. Post-operative (Ward) • Early mobility • Self management – exercise programme and mobility • Catheter – In/Out • Avoid bed pans THERE IS NO BETTER FEELING THAN FEELING NORMAL

  15. Ward (Physio & Nurse Lead) • Self mobility • Positive feedback • Act quickly where needed • Re-assure re point of contact • Inform Consultant of any problems after discharge • Contact telephone for follow up

  16. Enhanced Recovery Thanks to Jackie Stayton For leading this project THANK YOU

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