Hip arthroplasty - Revision history

Tony.Wang at 18:09, 12 July 2023

2023-07-12T18:09:48Z

← Older revision		Revision as of 11:09, 12 July 2023
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	\|0.75%		\|0.75%
	\|Isobaric		\|Isobaric
	\|18-25 mg		\|15-22.5 mg
	\|120 (motor)		\|120 (motor)
	170 (sensory)		170 (sensory)

Tony.Wang: Added ropivacaine

2023-07-12T17:43:58Z

Added ropivacaine

← Older revision		Revision as of 10:43, 12 July 2023
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	epinephrine addition		epinephrine addition
			\|-
			\|Ropivacaine<ref>{{Cite journal\|last=Gadre\|first=Akshay Kishore\|last2=Bandyopadhyay\|first2=Kasturi Hossain\|last3=Dutta\|first3=Chumki\|last4=Nag\|first4=Tulsi\|date=2019-12\|title=A Comparative Study of Intrathecal Isobaric 0.5% Bupivacaine and Intrathecal Isobaric 0.75% Ropivacaine in Elective Lower Segment Cesarean Section\|url=http://journals.sagepub.com/doi/10.4103/jpp.JPP_80_19\|journal=Journal of Pharmacology and Pharmacotherapeutics\|language=en\|volume=10\|issue=4\|pages=126–131\|doi=10.4103/jpp.JPP_80_19\|issn=0976-500X}}</ref>
			\|0.75%
			\|Isobaric
			\|18-25 mg
			\|120 (motor)
			170 (sensory)
			\|
	\|}		\|}
	Standard consideration of patient factors as they related to absolute/relative contraindications should be undertaken. Additional considerations for post operative mobilization. Some surgical teams and fast tracking joint replacement centers may mobilize patients as early as 2-4 hours postoperatively to help prevent DVT. <ref>Chua, Matthew J et al. “Early mobilisation after total hip or knee arthroplasty: A multicentre prospective observational study.” ''PloS one'' vol. 12,6 e0179820. 27 Jun. 2017, doi:10.1371/journal.pone.0179820</ref>		Standard consideration of patient factors as they related to absolute/relative contraindications should be undertaken. Additional considerations for post operative mobilization. Some surgical teams and fast tracking joint replacement centers may mobilize patients as early as 2-4 hours postoperatively to help prevent DVT. <ref>Chua, Matthew J et al. “Early mobilisation after total hip or knee arthroplasty: A multicentre prospective observational study.” ''PloS one'' vol. 12,6 e0179820. 27 Jun. 2017, doi:10.1371/journal.pone.0179820</ref>

Bfarler: PENG blocks are a slightly newer but growing and accepted block for hip arthroplasty.

2022-09-01T11:45:01Z

PENG blocks are a slightly newer but growing and accepted block for hip arthroplasty.

← Older revision		Revision as of 04:45, 1 September 2022
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	* fascia iliaca		* fascia iliaca
	*lumbar ESP (Erector spinae plane) block		*lumbar ESP (Erector spinae plane) block
			*PENG Block (Pericapsular Nerve Group Block/Hip Block)

	== Intraoperative management ==		== Intraoperative management ==

Aharari at 19:29, 18 July 2022

2022-07-18T19:29:04Z

← Older revision		Revision as of 12:29, 18 July 2022
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	* quadratus lumborum (QL)		* quadratus lumborum (QL)
	* fascia iliaca		* fascia iliaca
			*lumbar ESP (Erector spinae plane) block

	== Intraoperative management ==		== Intraoperative management ==

Mitchel.DeVita at 06:35, 31 May 2022

2022-05-31T06:35:30Z

@@ Line 142: / Line 142: @@
 * quadratus lumborum (QL)
 * fascia iliaca
 == Intraoperative management ==
-=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
+=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
 Standard ASA monitoring. Consider addition of intraoperative EEG monitoring (BIS or similar).
 large-bore PIV should be obtained. Arterial line for hemodynamic monitoring should be considered for revision procedures, cases with predicted significant blood loss, and for patients with significant cardiopulmonary disease.
-=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
+=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
 Induction can be tailored to individual patient comorbidities and acuity. RSI induction is indicated for trauma patients or those without proper fasting per ASA guidelines. For patients with rheumatoid arthritis, special consideration should be given to the airway and potential for cervical (atlanto-occipital) instability. In these cases, videolaryngoscopy or fiberoptic intubation should be considered and utilized.
 Induction and intubation on the preoperative bed prior to moving to the operating room table should be considered if possible for patients in whom it would cause significant pain (and resultant physiologic and emotional stress) to execute this move.
-=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
 {| class="wikitable wikitable-horizontal-scroll"
 |+
@@ Line 197: / Line 186: @@
 |}
 If lateral positioning, a beanbag and axillary roll are typically used. Additional blankets/pillows/foam will be needed for under the patients head (to ensure neutral positioning of  cervical spine) and to cushion the upper extremities. Reassess padding of pressure points, eye/ear position, monitors, and PIV patency after positioning is complete and prior to case start.
 === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

Mitchel.DeVita at 06:26, 31 May 2022

2022-05-31T06:26:49Z

@@ Line 142: / Line 142: @@
 * quadratus lumborum (QL)
 * fascia iliaca
 == Intraoperative management ==

Mitchel.DeVita at 06:11, 31 May 2022

2022-05-31T06:11:50Z

← Older revision		Revision as of 23:11, 30 May 2022
Line 33:		Line 33:
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|Standard evaluation		\|Standard evaluation including NPO status
	\|-		\|-
	\|Hematologic		\|Hematologic
Line 42:		Line 42:
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|Standard evaluation		\|Standard evaluation, blood sugar control important for postoperative wound healing
	\|-		\|-
	\|Other		\|Other
Line 78:		Line 78:
	{\| class="wikitable wikitable-horizontal-scroll"		{\| class="wikitable wikitable-horizontal-scroll"
	\|+		\|+
	* Two level regression
	!Drug		!Drug
	!Conc.		!Conc.
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	epinephrine addition		epinephrine addition
	\|}		\|}
	Standard consideration of patient factors as they related to absolute/relative contraindications should be undertaken.		Standard consideration of patient factors as they related to absolute/relative contraindications should be undertaken. Additional considerations for post operative mobilization. Some surgical teams and fast tracking joint replacement centers may mobilize patients as early as 2-4 hours postoperatively to help prevent DVT. <ref>Chua, Matthew J et al. “Early mobilisation after total hip or knee arthroplasty: A multicentre prospective observational study.” ''PloS one'' vol. 12,6 e0179820. 27 Jun. 2017, doi:10.1371/journal.pone.0179820</ref>

	Time of procedure should also be considered, as spinal anesthesia has a limited duration of action (typically 2-3 hours, depending on agents used).		Time of procedure should also be considered, as spinal anesthesia has a limited duration of action (typically 2-3 hours, depending on agents used).
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	Intrathecal long-acting morphine can be considered for postoperative pain control with an understanding that patient selection is important for administration of this medication given the risk for respiratory depression and long duration of action.		Intrathecal long-acting morphine can be considered for postoperative pain control with an understanding that patient selection is important for administration of this medication given the risk for respiratory depression and long duration of action.

	Single shot peripheral regional nerve blocks can be used to improve postoperative analgesia, but are not sufficient as a primary anesthetic. Patients must be able to assume the position required to place these blocks. Blocks used include:		Single shot peripheral regional nerve blocks can be used to improve postoperative analgesia, but are not sufficient as a primary anesthetic. Patients must be able to assume the position required to place these blocks. Blocks can help reduce postoperative opiate requirements. Blocks used include:

	* femoral		* femoral
Line 147:		Line 146:

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
	Standard ASA monitoring. Consider addition of intraoperative EEG monitoring.		Standard ASA monitoring. Consider addition of intraoperative EEG monitoring (BIS or similar).

	2 large-bore PIV should be obtained. Arterial line for hemodynamic monitoring should be considered for revision procedures, cases with predicted significant blood loss, and for patients with significant cardiopulmonary disease.		2 large-bore PIV should be obtained. Arterial line for hemodynamic monitoring should be considered for revision procedures, cases with predicted significant blood loss, and for patients with significant cardiopulmonary disease.

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:40:15Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:40, 5 April 2022
Line 4:		Line 4:
	\| airway = ETT if general		\| airway = ETT if general
	\| lines_access = Large bore IV		\| lines_access = Large bore IV
	± ~~Art~~ line		± Arterial line
	\| monitors = Standard		\| monitors = Standard
	± ABP		± ABP

Chris.Rishel at 07:44, 5 April 2022

2022-04-05T07:44:50Z

← Older revision		Revision as of 00:44, 5 April 2022
Line 1:		Line 1:
	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = ~~GA vs Neuraxial (~~spinal)		\| anesthesia_type = General or spinal
	\| airway = ETT		± Regional
	\| lines_access = ~~large~~ bore ~~PIV x2, +/- arterial~~ line		\| airway = ETT if general
	\| monitors = Standard ~~ASA~~		\| lines_access = Large bore IV
	\| considerations_preoperative = ~~Standard~~		± Art line
			\| monitors = Standard
			± ABP
			\| considerations_preoperative =
	\| considerations_intraoperative = Risk for bone cement implantation syndrome (BCIS)		\| considerations_intraoperative = Risk for bone cement implantation syndrome (BCIS)
	\| considerations_postoperative = Multimodal analgesia		\| considerations_postoperative = Multimodal analgesia

Chris.Rishel at 05:39, 27 March 2022

2022-03-27T05:39:57Z

← Older revision		Revision as of 22:39, 26 March 2022
Line 264:		Line 264:

	== References ==		== References ==
			<references />
	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
	~~<references />~~
	[[Category:Orthopedic surgery]]		[[Category:Orthopedic surgery]]
			[[Category:Hip surgery]]
	[[Category:Joint replacement surgery]]		[[Category:Joint replacement surgery]]