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Enhanced Recovery: Standardising anaesthetic technique

2010 November 7
by webmaster

We are keen to showcase examples of good enhanced recovery practice on the blog and this week we have a guest blog entry from David McDonald who is the  “CALEDonian technique” Co-ordinator at the Golden Jubilee National Hospital, Glasgow. His blog addresses the topic of how to standardised anaesthetic technique. This is frequently reported as a challenge for units when we visit hospitals around the country, and David’s blog illustrates that by using good data collection and audit you can standardise practice across departments and ensure you improve the quality and safety of your interventions.

Enter David….

“Within the Golden Jubilee National Hospital we have an established regime for Enhanced Recovery following total hip and knee replacements. We are the National waiting times centre in Scotland for orthopaedics and specialise in lower limb arthroplasty and currently perform around 3000 replacements per year (20% of Scotland’s total.)This has been developed following a departmental visit to Copenhagen in 2006 and been developed to suit our own in-house needs.

This involves a Comprehensive patient care plan of which the vital components are: Pre-operative assessment and education, positive attitudes, multimodal analgesia and accelerated rehabilitation.

With the Total Hip Replacements we had a group of surgeons who were happy with the use of an epidural as post operative pain management and another group who had moved as with the Total Knees to local anaesthetic infiltration in theatre with local bolus top ups performed in the ward. We were keen to establish if either regime provided better outcomes immediately post op. The audit looked at this and found no clinical difference in pain scores, immediate post operative complications or length of stay. This demonstrated that the use of LIA was as effective as an epidural without the obvious risk associated with an epidural. It was therefore decided to move to just infiltration and to remove the risk.

Since the completion of this audit we have looked a the use of the bolus top ups and again found that in fact in the hip they did not provide any further benefit and have since been removed and this has reduced the work load for nursing staff and costs of the overall pathway.”

To download a PDF poster detailing each project, click on the links below.

ERP 2010 hip poster

ERP 2010 knee poster

Have you got an enhanced recovery project to share? If so, get in touch by clicking here and we will feature your work so that it can be shared with others.

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