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Fast-Track-Endoprothetik – intra- und postoperatives Management

Fast-track arthroplasty—intra- and post-operative management

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Zusammenfassung

Evidenzbasierte, interdisziplinäre Fast-Track-Behandlungskonzepte erlauben die schnellstmögliche und komplikationsarme Mobilisierung der Patienten nach Hüft- und Knieendoprothetik. Diese gelingt durch eine lokale Infiltrationsanästhesie im Rahmen eines multimodalen Schmerztherapiekonzeptes. Auf Blasenkatheter, Femoraliskatheter und Drainagen wird gänzlich verzichtet. Feste Bestandteile des intra- und postoperativen Managements sind die Gabe von Tranexamsäure zur Reduktion der Blutung und Transfusionshäufigkeit. Kortison wirkt analgetisch, antiemetisch und reduziert die postoperative Stressantwort. Minimalinvasive Operationstechniken und der Verzicht auf die Blutsperre ermöglichen ein besseres funktionelles Ergebnis und bewirken weniger Schmerzen. Verbote und Restriktionen sind nicht evidenzbasiert und daher verzichtbar.

Abstract

Fast-track concepts in hip and knee arthroplasty focus on an early and safe mobilisation after surgery using a multi-modal pain concept with local infiltration anaesthesia. No drains, femoral nerve blocks or urinary catheters are used. Tranexamic acid reduces blood loss and transfusion rates. Cortisone is helpful in reducing pain, PONV and postsurgical stress response. Minimal invasive surgical techniques and the renouncement of a tourniquet lead to a better functional result and less pain. Restrictions and precautions are not evidence-based and should, therefore, be abandoned.

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Abbreviations

ERAS:

„Enhanced recovery after surgery“

KG :

Körpergewicht

LIA :

Lokale Infiltrationsanästhesie

NSAR :

Nichtsteroidale Antirheumatika

PONV :

Postoperative Übelkeit und Erbrechen

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Authors and Affiliations

  1. Vulpius Klinik GmbH, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland

    M. Clarius & L. M. Clarius

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  1. M. Clarius
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  2. L. M. Clarius
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Correspondence to M. Clarius.

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Interessenkonflikt

M. Clarius ist Mitglied des European Advisory Boards „Rapid Recovery“ von Zimmer Biomet und hat für entsprechende Vortragstätigkeiten Honorare und Fahrtkostenerstattungen erhalten und bekommt Forschungsunterstützung von Zimmer Biomet und von B Braun/Aesculap. L.M. Clarius gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Clarius, M., Clarius, L.M. Fast-Track-Endoprothetik – intra- und postoperatives Management. Orthopäde 49, 318–323 (2020). https://doi.org/10.1007/s00132-020-03867-y

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