In the present paper the authors discuss the history of fast-track formation, its development and current status. Fast-track advantages in comparison to other rehabilitation options are analyzed. The focus is placed on methods of accelerated rehabilitation after total hip and knee arthroplasty in the leading European and American clinics. Fast-track protocols of surgical centers of Denmark and Hospital for special surgery in the US are described, factors that determine time of hospital stay after total hip and knee arthroplasty are considered, predictors of hospital stay and patients satisfaction after the surgery are examined. The paper reflects the results of the comparison of frequency of thromboembolic and other complications as well as readmission rate after traditional rehabilitation and after fast-track. The paper considers fast-track in bilateral total knee replacement. The authors conclude that further research on acceleration of rehabilitation and reduction of hospital stay after total hip and knee arthroplasty needs to be focused on the optimization of pain relief, especially after discharge, blood preservation techniques, supplementation of fluids loss and strengthening of muscles. Literature analysis demonstrated that the implementation of the Protocol for accelerated recovery after joint arthroplasty in Russia is at an insufficient level. Data of foreign multicenter studies during recent years indicate a high efficacy and safety of this technique in different groups of patients.
Хирургия позвоночника 3/2007 (c. 59-64) анестезиология и реани матология © М М. .Н Н.. Л Ле еб бе ед де ев ва а и и д др р. ., , 2007 Хирургия позвоночника 3/2007 (c. 59-64) анестезиология и реаниматология М М. .Н Н.. Л Ле еб бе ед де ев ва а и и д др р.. Технологии кровосбережения в хирургии сколиоза
To perform quantitative assessment of intraoperative blood loss volume and severity during stages of idiopathic scoliosis surgical correction. Material and Methods. Data of intraoperative blood loss during stages of surgical correction of idiopathic scoliosis were analyzed in 1241 operated patients. Multi-stage surgical interventions were performed in 581 (46.8 %) patients, posterior fusion-in 660 (53.2 %), and multilevel corrective vertebrectomy-in 72 (12.4 %) patients. Two methods of general anesthesia were used: TIVA with propofol, fentanyl, tracrium, and with inhaled sevoflurane, fentanyl, and tracrium. Volumes of intraoperative blood loss were assessed at main stages of surgery. Results. Total intraoperative blood loss during multistage surgical treatment with segmental hook instrumentation was 967.4 ± 43.6 ml, and with hybrid instrumentation-1135.9 ± 139.5 ml. Blood loss during posterior only fusion procedure was 865.5 ± 40.1 ml with segmental hook instrumentation, and 1049.9 ± 75.5 ml with hybrid instrumentation. Multilevel vertebrectomy was associated with maximum intraoperative blood loss of 1242.9 ± 121.8 ml. Conclusion. Intraoperative blood loss during surgical correction of idiopathic scoliosis varies considerably and averages from 20.0 to 40.0 % of the circulatory blood volume. The duration of surgical intervention is the main proved factor influencing the volume of blood loss.
Проблема обезболивания после операции эндопротезирования тазобедренного сустава остается актуальной задачей. Эффективным методом послеоперационного обезболивания является продленная эпидуральная анальгезия местными анестетиками. Целью исследования было изучение эффективности и безопасности эпидуральной анальгезии левобупивакаином в сравнении с ропивакаином у пациентов после эндопротезирования тазобедренного сустава. Материалы и методы. Исследованы 50 пациентов после первичной тотальной артропластики тазобедренного сустава. Они были рандомизированы на 2 группы. В первой группе послеоперационное эпидуральное обезболивание проводили инфузией левобупивакаина, во второй-инфузией ропивакаина. Исследованы динамика болевого синдрома после операции, необходимость дополнительной анальгезии, стабильность гемодинамических показателей. Результаты исследования. Полученные данные свидетельствуют о лучшем контроле болевого синдрома в группе левобупивакаина в первые часы после операции. Средние баллы оценки боли по 10-балльной визуально-рейтинговой шкале в группе левобупивакаина были 4,36 ± 2,46 против 5,84 ± 1,46 в группе ропивакаина. В дальнейшем контроль болевого синдрома в исследуемых группах был сопоставим. Количество эпизодов гипотонии и потребность в наркотических анальгетиках в обеих группах значимо не отличались. Заключение. Использование продленной эпидуральной анальгезии левобупивакаином может быть рекомендовано для обезболивания после эндопротезирования тазобедренного сустава. Ключевые слова: левобупивакаин, ропивакаин, эндопротезирование тазобедренного сустава, эпидуральная анестезия, эпидуральная анальгезия.
Objective: To evaluate the effect of feeding with a whey protein plus carbohydrate drink on metabolic parameters, general state of the patient and recovery time after knee and hip arthroplasty. Methods: The results of the perioperative period of 60 patients with osteoarthritis (OA) of the hip and knee were evaluated between March and July 2021. All patients underwent hip or knee arthroplasty under spinal anaesthesia. In addition, patients of the study group received the ProvideXtra® Drink 2 hours before surgery. Otherwise, the management of patients in the perioperative period was the standard. Mobilisation and verticalisation of patients were carried out after achieving physical fitness, resolution of the spinal block and haemodynamic stability on the day of surgery or the next day. Results: In all patients after 4 hours, increased glucose levels were recorded in both groups, statistically significant in the control group – 7.15±0.94 versus 7.88±1.18 mmol/l (p=0.02). The decrease in haemoglobin level had no difference in the study groups and before discharge was 100±16 g/l versus 101±18 g/l (p=0.86). The difference in total protein level before discharge was in favour of the study group, 63.1±6.1 versus 59.2±5.9 g/l (p=0.17). Verticalisation timing in the study group was as follows: 10 patients were verticalised on the day of surgery, and the remaining 20 patients – were on the next day. In the control group – 8 patients were verticalised on the day of surgery and 22 – on the next day. In the control group, 2 cases of postoperative nausea requiring correction were observed. Conclusion: The modern surgical approaches include the maximal preservation of natural feeding, based on the Enhanced Recovery after Surgery (ERAS®) concept. However, guidelines for choosing a particular diet on the day of surgery remain to be finally established. Using ready-made carbohydrate-protein mixtures is a convenient solution that delivers the required amount of energy and protein. Therefore, the effect of the mixture on protein metabolism in the postoperative period remains to be elucidated through further studies. Keywords: Accelerated rehabilitation, nutrient mixture, hip arthroplasty, knee arthroplasty.
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