Less nausea and vomiting

These patients have received little or no opiates and therefore less prone to nausea and vomiting. They are also less sedated.

5) Reduced need for intravenous infusions/drains /urinary catheters etc

Generally the surgeon does not insert a drain.

The aim is to discontinue the intravenous infusion as soon as possible (I.V access is maintained)

Unlike with epidurals or spinal opiates, patients with local anaesthetic infusions should not need a urinary catheter. However, urine output should be monitored closely. If a patient has not passed urine 12 hours after their operation then a bladder scan should be performed and, if necessary the patient should be catheterised.

6) Patients can be encouraged to return to “normal” as soon as possible

These patients feel better because of the absence of drains, drips, catheters. Also with less sedation and nausea (hopefully!) we can encourage these patients to wear their own clothes, eat at a table instead of in a bed, go to the toilet instead of using a commode etc.

7) Chronic pain patients (i.e patients who have been taking opiates for some time prior to the operation) are managed differently. Many of these patients will have a pre-operative plan written in the notes from when they were seen at the pre-assessment clinic. Generally chronic pain patients should still receive the intra-articular wound infusion but they should be prescribed Patient Controlled Analgaesia (PCA) rather than the Oxycontin tablets. This is because these patients have unpredictable analgaesic requirements. They may also require large amounts of oromorph after the PCA has been discontinuedThese patients should also continue their pre-existing opiates into the post-operative period. It is most important that analgaesia patches stay in place and are re-applied as prescribed. If in doubt please contact the Enhanced Recovery Sister on bleep 1233 within normal working hours.

8) Sleep apnoea patients- These patients receive the intra-articular Ropivacaine infusion but should have a Patient Controlled Analgaesia device instead of the Oxycontin. If their sleep apnoea is severe they should be managed on HDU.

Potential Hazards:

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