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Perioperative Vorgehensweisen in der Fast-Track-Endoprothetik

Perioperative management in fast-track arthroplasty

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Zusammenfassung

Die Optimierung der organisatorischen Abläufe sowie der intra- und perioperativen chirurgischen Vorgehensweisen sind wesentliche Bestandteile von Fast-Track-Programmen in der klinischen Routine. Fokus dieser Behandlungskonzepte ist die frühpostoperative Mobilisation der Patientinnen und Patienten nach Gelenkersatzoperation im interdisziplinären Setting mit dem Ziel, Schmerzen und Komplikationen nachweislich zu vermeiden. Dieser Beitrag soll einen umfassenden und detaillierten Überblick hinsichtlich der evidenzbasierten perioperativen Fast-Track-Vorgehensweisen geben: angefangen bei der Schmerztherapie mit intraoperativer lokaler Infiltrationsanalgesie und Tranexamsäure-Applikation unter minimal-invasivem chirurgischem Vorgehen in kurzwirksamer Spinalnarkose bis hin zum Verzicht auf Drainagen, regionale Schmerz- und Blasenkatheter, Blutsperren sowie Restriktionen.

Abstract

The optimization of organizational processes, as well as surgical procedures intra- and perioperatively, are essential components with respect to fast-track programs in clinical routine. Treatment concepts focus on early postoperative mobilization of patients after joint replacement surgery in an interdisciplinary setting to avoid pain and complications on a scientific basis. This article gives a comprehensive and detailed overview regarding evidence-based peri- and intraoperative fast-track treatment methods: from pain treatment with intraoperative local infiltration analgesia and tranexamic acid application under minimally invasive surgical approach in short-lasting spinal anesthesia to renunciation of drains, regional pain- and urinary catheters, tourniquets, and restrictions.

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Abbreviations

ADL:

Activities of Daily Living

AWMF :

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

LIA :

Lokale Infiltrationsanalgesie

NSAR :

Nichtsteroidale Antirheumatika

PONV :

„Postoperative nausea and vomitting“

VAS :

Visuelle Analogskala

WHO :

World Health Organization

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland

    Felix Greimel &  Günther Maderbacher

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  1. Felix Greimel
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  2. Günther Maderbacher
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Correspondence to Felix Greimel.

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F. Greimel und G. Maderbacher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt.

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Greimel, F., Maderbacher, G. Perioperative Vorgehensweisen in der Fast-Track-Endoprothetik. Orthopäde 51, 366–373 (2022). https://doi.org/10.1007/s00132-022-04244-7

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