Abstract

Aims and objectives: The aim of this integrative review is to provide current, evidence-based anesthetic and analgesic recommendations for inclusion in an enhanced recovery after surgery (ERAS) protocol for patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).

Methods: Articles published between 2006 and December 2016 were critically appraised for validity, reliability, and rigor of study.

Results: The administration of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, and steroids result in shorter hospital length of stay (LOS) and decreased postoperative pain and opioid consumption. A spinal anesthetic block provides benefits over general anesthesia, such as decreased 30-day mortality rates, hospital LOS, blood loss, and complications in the hospital. The use of peripheral nerve blocks result in lower pain scores, decreased opioid consumption, fewer complications, and shorter hospital LOS.

Conclusion: Perioperative anesthetic management in ERAS protocols for TKA and THA patients should include the administration of acetaminophen, NSAIDs, gabapentinoids, and steroids. Preferred intraoperative anesthetic management in ERAS protocols should consist of spinal anesthesia with light sedation. Postoperative pain should be managed with peripheral nerve blocks such as adductor canal block or femoral nerve block supplemented with sciatic nerve block or local infiltrated anesthesia.

Laura Oseka

Author Details

Laura Oseka, DNAP, CRNA

Sigma Membership

Non-member

Type

Other Graduate Paper

Format Type

Text-based Document

Study Design/Type

Literature Review

Research Approach

N/A

Keywords:

Anesthetic Management, Enhanced Recovery after Surgery Protocols, Total Knee Arthroplasty, Total Hip Arthroplasty

Advisor

Pecka, Shannon

Degree

Doctoral-Other

Degree Grantor

Bryan College of Health Sciences

Degree Year

2017

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All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Faculty Approved: Degree-based Submission

Acquisition

Proxy-submission

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