Clinical audit standards

All patients will be audited for quality of analgaesia, mobility, length of stay, and complications including infection. The database will be reviewed quarterly by the Enhanced Recovery Team and will be presented annually to the Trust Board, the Orthopaedic department and the Anaesthetic department.

Summary of development and consultation process undertaken before registration and dissemination

During its development this guideline has been circulated for comment to: the anaesthetic department, the orthopaedic department, the pharmacy department, the Acute Pain Service, Ward sisters on Denton, Gateley, Earsham and Cringleford, the Physiotherapy department, the Occupational Therapy department.

This version has been endorsed by the Clinical Guidelines Assessment Panel.

Distribution list/ dissemination method

Trust Intranet, Orthopaedic wards, orthopaedic theatres Recovery, Orthopaedic surgeons, orthopaedic anaesthetists, Acute Pain Team, physiotherapy department, occupational therapy department.

References/ source document

Andersen KV. Pfeiffer-Jensen M. Haraldsted V. & Søballe K. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty. A randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthopaedica 2007, 78 (2), 180 – 186.

Busch CA. Shore BJ. Bhandari R. Ganapathy S. MacDonald SJ. Bourne RB. et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am, 2006, 88, 959 – 963.

Husted H. Holm G. & Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthopaedica 2008, 79 (2), 168 – 173.

Isaac D. Falode T. Liu P. I’Anson H. Dillow K. Gill P. Accelerated rehabilitation after total knee replacement. Knee, 2005, 12, 346 – 350.

Kerr DR. & Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthopaedica 2008, 79 (2), 174 – 183.

Piper SL. and HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am 2008, 90, 986 – 991.

Rasmussen S. Kramhøft MU. Sperling KP. & Pedersen JHL. Increased flexion and reduced hospital stay with con­tinuous intraarticular morphine and ropivacaine after primary total knee replacement: Open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand 2004, 75 (5), 606 – 609.

Röstlund T. & Kehlet H. High-dose local infiltration analgesia after hip and knee replacement—what is it, why does it work, and what are the future challenges? Acta Orthopaedica 2007, 78 (2), 159 – 161.

Toftdahl K. Nikolajsen L. Haraldsted V. Madsen F. Tønnesen EK. & Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty; A randomized clinical trial. Acta Orthopaedica 2007, 78 (2), 172 – 179.

Vendittoli P. Makinen P et al A multimodal Analgaesia protocol for Total Knee Arthroplasty. A Randomised Controlled Study J Bone Joint Surg Am 2006; 88:282-289

Bianconi M, Ferraro L, et al Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. British Journal Of anaesthesia 91 (6) 830-5 (2003)

Wiedermann D, Muhlnickel B, Staroske E, Neumann Rose w. Ropivacaine plasma concentration after 120 hour epidural infusion Br J Anaesth 2000; 85: 830-5

Wulf H, Worthmann F,Behnke H, Bohle A S. Pharmacokinetics and pharmacodynamics of ropivacaine 2mg/mL, 5mg/mL, or 7.5mg/mL after ileoinguinal blockade for ileoinguinal hernia repair in adults Anesth Analg 1999; 89: 1471-4

Burm AGL, Stienstra R, Browwer R,et al Epidural infusion of ropivacaine for postoperative analgaesia after major orthopaedic surgery. Anaesthesiology 2000; 93: 395-403

Petterson N, Emanuelson BM, Reventlid H, Hahn RG. High-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair: a clinical and pharmacokinetic evaluation. Reg Anaes Pain Med 1998: 23: 189-96

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