Anesthetic Management in ERAS Protocols for Total Knee and Total Hip Arthroplasty: An Integrative Review
Laura Oseka, DNAP, CRNA
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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.
|Other Graduate Paper||Proxy-submission||Faculty Approved: Degree-based Submission||Text-based Document|
|Level of Evidence||Research Approach||Keywords||CINAHL Subject(s)|
|Literature Review||N/A||anesthetic management; |
enhanced recovery after surgery protocol;
total knee arthroplasty;
total hip arthroplasty;
Arthroplasty, Replacement, Hip;
Arthroplasty, Replacement, Knee;
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