Regional Gurus- Need Help Dev Outpatient Total Joint Program

[masterPain]

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We are having extended stays for our total joints, lasting two and three days. I know the new literature shows appropriate regional anesthesia can get them out within 23 hours, which seems standard for most orthopedic hospitals.

I haven’t done full-time general Anesthesia for three or four years now. Typically for TKA, I would perform adductor canal with iPack. I know some people started performing ultrasound guided genicular blocks. For THA, I would do fascia iliaca, however, you would get femoral nerve involvement. I then started doing PENG blocks for motor sparing purposes. For reverse total shoulder arthroplasty, I would float interscalene perineural catheter with OnQ balls.

I know a lot of the above has been improved with use of liposomal bupivacaine.

Your help is much appreciated!

 

[CopaceticOne]

TKA = spinal + iPACK SS + ACB catheter
THA = spinal
Shoulder = GA + interscalene (catheter vs exparel depending on the patient)

OnQ for the catheters. At least 50% leg joints are same day discharge.

 

[2019medstudent]

See if your surgeons will do R.E.C.K joint injections. Their joint patients leave the same day and we haven’t needed to do any rescue blocks or catheters for a few years. For shoulders, we do exparel and no catheters

 

[pgg]

TKA = spinal + iPACK SS + ACB catheter
THA = spinal
Shoulder = GA + interscalene (catheter vs exparel depending on the patient)

OnQ for the catheters. At least 50% leg joints are same day discharge.

I'm surprised anyone is still doing catheters for these cases. Kudos if you've got the bandwidth to do them and the buy-in from everyone else. I haven't even seen a take-home nerve block pump in at least 10 years.

Here - single shot blocks + opioids + GA + same day discharge.

IMO there's no point to doing a spinal for a TKA for outpatients, since you can't use intrathecal morphine. Put them to sleep and be done with it.

 

[masterPain]

See if your surgeons will do R.E.C.K joint injections. Their joint patients leave the same day and we haven’t needed to do any rescue blocks or catheters for a few years. For shoulders, we do exparel and no catheters

Do you still do regional nerve blocks with the R.E.C.K. injections?

 

[Lab Lover]

Mepivacaine Isobaric Spinals for THA and TKA. +/- single shot ACB with 10ml exparel and 10ml 0.5% Bupivacaine.

 

[JoelJoel84]

Mepivacaine Isobaric Spinals for THA and TKA. +/- single shot ACB with 10ml exparel and 10ml 0.5% Bupivacaine.

Absolutely what I do as well , except for 20ml Exparel and 10 ml 0.5% Bupi. IV decadron as well.

Not one complaint from a single patient or surgeon over 5 years, and I’ll often call the patient to follow up out of curiosity and they maybe took one Oxy on POD 3, with Motrin and Tylenol.

They wake up super clear and fresh in PACU from low dose propofol gtt, working with Pt right away and home within 2 hours post op.

We’ll do 5-6 TKAs and be done by 3pm, with all patients home by 5pm.