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Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored.

Patient contact by telephone the day before ambulatory surgery is considered as a best practice. The Short Message Service (SMS) could be a suitable alternative. The objective of this prospective study was to evaluate the interest of preoperative instruction (PI) reminders by SMS compared to telephone calls. This was a prospective single center before-and-after study. Patients scheduled in ambulatory surgery were included during 2 consecutive periods of 10 weeks. The "Call" group received a telephone call for preoperative instructions (PI) and the "SMS" group received an automated protocol SMS reminder. The primary endpoint was patient compliance with PI and time of convocation. The two populations were compared with a non-inferiority hypothesis and the impact of the contact modality on compliance with the PI was assessed using a propensity score. The analysis concerned 301 patients in the Call group and 298 in the SMS group. The absence of dysfunction was observed in 75% of patients in the SMS group compared with 61% in the Call group (Risk difference: 14% [95%CI: 7-21]). The use of SMS was associated with a significant improvement in compliance with the PI (Odds ratio: 1.90 [1.48-2.42]; p < 0.0001). Patient satisfaction was similar regardless of the method of PI reminders. The automation of preoperative SMS reminders is associated with a better respect of the PI compared to the conventional calling method. This PI reminder method satisfies the majority of patients and may have a favorable financial impact.

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Background The Aldrete’s score is used to determine when a patient can safely leave the Post-Anaesthesia Care Unit (PACU) and be transferred to the surgical ward. The Aldrete score is based on the evaluation of vital signs and consciousness. Cognitive functions according to the anaesthetic strategy at the time the patient is judged fit for discharge from the PACU (Aldrete’s score ≥ 9) have not been previously studied. The aim of this trial was to assess the cognitive status of inpatients emerging either from desflurane or propofol anaesthesia, at the time of PACU discharge (Aldrete score ≥ 9). Methods Sixty adult patients scheduled for hip or knee arthroplasty under general anaesthesia were randomly allocated to receive either desflurane or propofol anaesthesia. Patients were evaluated the day before surgery using Digit Symbol Substitution Test (DSST), Stroop Color Test and Verbal Learning Test. After surgery, the Aldrete score was checked every 5 min until reaching a score ≥ 9. At this time, the same battery of cognitive tests was applied. Each test was evaluated separately. Cognitive status was reported using a combined Z score pooling together the results of all 3 cognitive tests. Results Among the 3 tests, only DSST was significantly reduced at Aldrete Score ≥ 9 in the Desflurane group. Combined Z-scores at Aldrete Score ≥ 9 were (in medians [interquartils]): − 0.2 [− 1.2;+ 0.6] and − 0.4 [− 1.1;+ 0.4] for desflurane and propofol groups respectively (P = 0.62). Cognitive dysfunction at Aldrete score ≥ 9 was observed in 3 patients in the Propofol group and in 2 patients in the Desflurane group) (P = 0.93). Conclusion No difference was observed in cognitive status at Aldrete score ≥ 9 between desflurane and propofol anaesthesia. Although approximately 10% of patients still had cognitive dysfunctions, an Aldrete score ≥ 9 was associated with satisfactory cognitive function recovery in the majority of the patients after lower limb arthroplasty surgery under general anaesthesia. Trial registration Clinical Trials identifier NTC02036736.