Best Infiltration Practices App

Hip and Knee Arthroplasty & Orthopedic Surgery

Best Infiltration Practices - local analgesic techniques for abdominal and orthopedic surgery

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Key Points Î Over one million hip and knee arthroplasties were performed in the United States in 2010 (http://www.cdc.gov/nchs/fastats/insurg.htm). Many can benefit from local analgesic wound infiltration. Î Despite recent advances, 86% of patients report moderate to extreme pain following surgery. Î Pain is the most common cause of hospital admissions after ambulatory surgery. Î Multimodal strategies using two or more analgesic agents and including administration of local analgesics are recommended by surgical pain guidelines — eg, American Pain Society (APS), American Society of Anesthesiologists (ASA), American Society of PeriAnesthesia Nurses (ASPAN), Department of Defense (DOD). 1-4, 9, 20 Î Since their clinical use was first demonstrated more than 120 years ago, local analgesics have provided an alternative to general anesthesia and an adjunct to better managing surgical pain that has proved beneficial for both patients and practitioners. 10, 12, 13, 15, 19 Î Managing surgical pain with minimal use of opioids has been shown to accelerate patient recovery; reduce complications, hospital stays and readmissions; and improve overall patient outcomes. 10, 12, 13, 15, 19 Î Wound infiltration with local analgesics has demonstrated benefits for reducing surgical pain and the use of opioids, minimizing expensive complications that cause patient harm and thereby shortening hospital stays and reducing readmissions. 10, 12, 13, 18 Î The recent addition of a 72-hour liposome formulation of bupivacaine substantially and favorably alters the paradigm for evaluating and using surgical wound infiltration in joint arthroplasty to improve pain scores, significantly reducing the need for opioids and improving patient satisfaction. 7 Î Always consider maximum dose and patient weight when infiltrating. Because amide-type local anesthetics such as bupivacaine are metabolized by the liver, they should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations. Î Improving local analgesic administration techniques can improve surgical pain outcomes and benefit patients. This is the goal of the Best Infiltration Practices Working Group and its expert recommendations. ÎInfiltration techniques vary from procedure to procedure, requiring knowledge of each surgical site and its anatomy to produce optimal results.

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