1 case of daytime total hip replacement perinamer management.

Day surgery is an operation performed within 24h of admission, surgery and discharge of a patient, with a specific condition of no more than 48h and excluding outpatient surgery.
recent years, the state has gradually attached importance to this high-efficiency diagnosis and treatment model.
hip replacement surgery in China has been increasing year by year, and with the rapid development of surgical and anesthesiological technology and the popularization of the concept of accelerated postoperative rehabilitation, hip replacement day surgery has become a reality.
-day surgery for total hip replacement has been widely carried out abroad, but no relevant literature has been reported in China.
is now the hospital recently successfully carried out a hip replacement day surgery reported below.
1. Patient data patient, male, 62 years old, height 162 cm, body mass 58 kg, due to "congenital right hip dysplate" line right full hip replacement day surgery.
no other medical history in the past.
: Blood pressure (BP) 120/65mmHg (1mmHg x 0.133kPa), heart rate (HR) 70 times/min, respiration frequency (RR) 14 times/min, cardiopulmonary stethosis no abnormalities.
blood routine, blood biochemical, electrocardiogram (ECG), chest tablets and lung function examination did not see any obvious abnormalities.
all examinations and anaesthetic assessments are completed in the outpatient clinic before admission.
Preparations before surgery at home: strengthen nutrition (appropriate intake of fish, pork, eggs, etc.);
6h fasting solid food before surgery and 2h oral 250mL glucose water before surgery.
was admitted to the hospital at 8:00 on the day of the operation, perfected medical documents, signed an informed consent, entered the operating room at 8:30, cut the skin at 9:30, ended at 11:00, and sent the patient back to the day ward for continued observation.
anaesthetic process: regular post-entry monitoring BP, HR, ECG and pulse oxygen saturation (SpO2), open intravenous passages, nasal catheter oxygen absorption (3L/min).
intravenous injection of midazolam 2mg, dezosin 5mg, under ultrasonic guidance to the right feline outer skin nerve block (probe placed in front of the shin in the lower, using the flat mode injection, injection 0.25% Rotikain 10mL), and closed-hole nerve blocking (probe placed on the inside of the eso artery parallel to the groin folds, using in-plane mode injection, respectively, blocking the front and rear support, a total of 0.25% Rophesin 20mL).
Reto-take the affected side on the upper, L3-4 line right side lumbar hemp, cobweb subcavity injection low-gravity rotikain 10mg, and then place the head end into the epidural catheter 4 cm, the highest blocking plane for T8, the epidural cavity did not add linen, the right lumbar hemp blocking time 150min, the right lower limb movement blocking improved Bromage score 3 points, left subsecond score 1 subsecond.
30min intravenous drips into cephalosporine 1g before peeling, 10min intravenous drips into ammonia cyclic acid 1g, Parishib 40mg and dexamissone 5mg, continuous intravenous pumping of right meetumidine 0.4?g/(kg?h), intravenous infusion compound sodium chloride injection 6mL/(kg-h), no blood transfusion.
stitching the wound, the inlet bureau drug is immersed layer by layer in anesthesia (Rophekain 100mg, dexamisone 5mg, ketochloric acid 30mg plus physiological saline for a total of 40mL), local injection of ammonia cyclic acid 1g.
operation lasted 90min, hemorrhage was about 200mL, the wound lead tube was retained, and the catheter was not placed.
effect of anaesthetic in surgery, the vital signs are stable, and the patient does not describe any discomfort.
patients were admitted to day wards after surgery to monitor BP, HR, ECG and SpO2, intravenous rehydration fluids.
At this time, both lower limbs of the patient have resumed motor function (improved Bromage score 0 points), pain visual simulation score (VAS) score 0 points, told the patient to drink a small amount of water; h-assisted double-turning out of bed walking, oral ammonia oxycodone analgesics; after surgery 20h pulled out the lead tube, normal diet, again bed-out activities; after surgery 29h discharge assessment scale score of 10 points, for discharge, home rehabilitation.
was ordered to give oral cephalosporine Clospheny capsules 3d (500mg/time), Devashaban tablets 5 weeks (10mg/d), on-demand oral ammonia oxycodone (325mg/s) analgesics, and to give specific rehabilitation guidance.
1st, 2nd and 7th days of telephone follow-up after surgery, the wound was in good condition, the pain VAS score was 2 to 3 points, the daily walking training was 30min, the diet was normal, and no other abnormalities were described.
30d door-to-door follow-up after surgery, wound healing, side-by-side walking, without describing discomfort.
2. Discussion of day surgery is a high-quality and efficient mode of diagnosis and treatment, can greatly alleviate China's current "difficult to see a doctor, expensive to see a doctor, hospital length" and other difficulties, in recent years, the attention of our government departments, many traditional operations began to be completed by day surgery.
Traditional total hip replacement, generally 10 to 14d hospitalization, and day surgery mode will be compressed to 24 to 48h hospitalization time, hospitalization time and medical costs greatly reduced, but get the same medical quality and safety, at the same time, also recognized by patients.
the case was the first total hip replacement day operation performed in our hospital, and it was successfully applied thanks to convenient day care models, the latest surgical and anaesthetic techniques and the concept of accelerated postoperative rehabilitation."
the basic principle of day surgery is that surgery has been shown to guarantee the quality of medical care and patient safety, with less bleeding, short surgery time and rapid postoperative recovery.
our hospital every year to carry out hip replacement surgery about 500 cases, mature technology, are completed within 2h, after surgery recovery satisfaction, therefore, suitable for day surgery.
if the patient's surgery is not complex, good physical condition, no basic disease, it is suitable for day surgery.
patient in this case had no underlying disease other than right hip lesions and was in good nutritional condition, so we chose to perform day surgery on them.
Hip replacement can be performed under total hemp or invertebral anesthesia, but for elderly patients, especially those with one-sided lower limb surgery, one-sided lumbar hemp is the best method of anesthesia, which has a small impact on the body's hemodynamics and rapid recovery after surgery, so this example takes one-sided lumbar hemp, achieving good results.
This example uses the post-outer path micro-invasive total hip replacement surgery, compared with traditional surgical methods, the trauma is smaller, less bleeding, faster recovery, creating conditions for early bed-out activities.
perfect analgesy is the basis of early bedtime activities after surgery, but also the premise of early discharge of day surgery patients.
This example uses multi-modal analgesic methods such as nonsteroidal analgesics, incision local immersion anesthesia and ultrasound-guided nerve blocking to provide a perfect analgesic after surgery and ensure that the patient walks out of bed as soon as possible after surgery, consistent with the literature.
further improve their nutritional status through diet 1 week before admission.
To reduce hunger and insulin resistance, a small amount of carbohydrate was taken orally at 2h before surgery, and after surgery, returning to the ward to begin drinking water and gradually transitioning to a normal diet provided nutritional support for early bed-out activities.
postoperative regular movement and anti-thrombosis treatment are beneficial to prevent venous thrombosis in the lower extremities.
follow-up within 30d after surgery, there were no wound infections, bleeding, blood clots and abnormal joint activity, and the recovery was satisfactory, indicating that the case was a complete success in daytime surgery mode.
to sum up, selecting the right patient, adopting the latest surgical and anaesthetic techniques and accelerating rehabilitation surgery concept, the whole hip replacement day surgery is safe and feasible, which is conducive to reducing the medical burden of patients and promoting patients to recover their health as soon as possible.
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