Anesthetic Management in Early Recovery After Surgery Protocols for Total Knee and Total Hip Arthroplasty.

Abstract

The aim of this integrative review was 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). Articles published between 2006 and December 2016 were critically appraised for validity, reliability, and rigor of study. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, and corticosteroids resulted in shorter hospital length of stay (LOS) and decreased postoperative pain and opioid consumption. A spinal anesthetic block provided benefits over general anesthesia, including decreased 30-day mortality rates, hospital LOS, blood loss, and complications. The use of peripheral nerve blocks for postoperative pain management resulted in lower pain scores, decreased opioid consumption, fewer complications, and shorter hospital LOS. Perioperative anesthetic management in ERAS protocols for patients undergoing TKA and THA should include the administration of acetaminophen, NSAIDs, gabapentinoids, and corticosteroids. 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.