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B312 Audit of enhanced recovery protocol for post operative THR and TKR
  1. N Doshi,
  2. S Murugesan and
  3. R Sharma
  1. WWL NHS trust, Wigan, UK


Background and Aims Background - Enhanced recovery(ER) is modern,evidence-based approach with focus on safe, effective analgesia with minimal side-effects which helps early mobility

Aims - to audit in postop period 1) pain scores 2) early mobilization 3) complication and delay discharges

Methods Methods - This is our ER protocol

  1. exclusion criteria -patients

    • Chronic pain patients who take regular, strong opioid prior to surgery.

    • severe renal impairment (CrCl<30 ml/min)

    • under the age of 18 years.

    • adverse reactions to oxycodone

    • Patient refusal.

  2. Anaesthetic methods - Single shot spinal anaesthetic,+/-sedation,+/-diamorphine orGeneral anaesthetic(GA)

  3. Postop order set-oxycodone MR and IR, Pregabalin,paracetamol,NSAIDs,PPI and laxative

Audit was conducted from June 2021- Sept 2021 after Audit registration in our NHS trust.

Results We have collected data from 32 patients

  1. Type of anaesthesia – 30 patients had SA with Diamorphine range 300 – 500 mcg , 1 patient SA was converted to GA,1 patient had GA .Local infiltration was given in 26 cases

  2. Mobilization – only 1 patients was mobilized by physiotherapy post op on the day of surgery , rest all were mobilized on day 1or 2

  3. Pain score – most patients had minimal pain,3 patients had severe pain for which they had PCA

  4. Dizziness – 3 patients complained of dizziness post op

  5. Catherization – 12 out of 32 patients required catherization post op

  6. Discharge – only 56% were discharge on day 2 or 3, rest were delayed

Conclusions We need to make some necessary changes in the ER protocol

  1. Avoid opiods in SA,this will decrease dizziness and requirement of catheterization in the immediate post op period,

  2. Train the nursing staff for early mobilization

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