Standardmedicinering ved THA/TKA
Formål
At beskrive standard medicin i forbindelse med primær total hofte- eller knæalloplastik.
Instruksen er gældende i hele Region Nord.
Præoperativt
Dexametason 24 mg IV
Tranexamsyre 1 g PO (Farsø og Frederikshavn) / IV (Aalborg)
Cefuroxim 1,5g/2,25g/3g IV– doseres efter vægt (<80 kg /80kg-120kg/ >120 kg).
Paracetamol 1 g PO (hvis anæstesiolog vurderer behov for anden dosering eller administrationsvej, så anføres dette i journal)
Celecoxib 400 mg PO
Pantoprazol 20 mg PO
Depot morfin gives ikke som standard, men efter individuel vurdering.
Tabletter administreres mindst 1 time før kirurgi. Intravenøst medicin administreres mindst 25 min. og maximalt 60 min. før knivtid.
Intraoperativt
TKA
Tranexamsyre 1 g opløst i 30 mL isoton saltvand. Injiceres i leddet efter lukning af kapsel
LIA – 100 mL naropin 2mg/mL
Adductorblok: til patienter opereret i GA samt smertepatienter
THA
20 ml naropin 5 mg/ml som kapselblok til pt i GA.
Der anvendes ikke LIA
Postoperativt
Cefuroxim 1,5 g 4 timer postoperativt
Paracetamol 1g x 4 PO
Ibuprofen 400 mg x 3 PO i 10 dage (hofte) / 14 dage (knæ). Opstart 1. postoperative døgn
Morfin 10 mg PN PO i 7 dage
Morfin 2,5 mg IV PN
Xarelto 10 mg PO – Indlæggelse >5 dage: kun under indlæggelse. Indlæggelse over 5 dage: 10 dage.
Pantoprazol 20 mg x 1 PO i 10 dage (hofte) / 14 dage (knæ)
Antiemetika efter regional rekommandation
Laksantia efter regional rekommandation
Referencer
1. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth 2019; 123(3):269-287.
2. Pu X, Sun JM. General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2019; 98(16):e14925.
3. Anger M, Valovska T, Beloeil H, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76(8):1082-1097.
4. Lunn TH, Andersen LØ, Kristensen BB, Husted H, Gaarn-Larsen L, Bandholm T, Ladelund S, Kehlet H. Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth. 2013 Jan;110(1):66-73. doi: 10.1093/bja/aes345. Epub 2012 Sep 17. PMID: 22986420.
5. Lunn TH, Kristensen BB, Andersen LØ, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth. 2011 Feb;106(2):230-8. doi: 10.1093/bja/aeq333. Epub 2010 Dec 3. PMID: 21131371.
6. Jørgensen CC, Petersen PB, Daugbjerg L, et al. Use of peripheral nerve blocks and postoperative outcomes in fast-track total hip and knee arthroplasty with length of stay ≤ 1 day. 2021.
7. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021. (Epub)
8. Karlsen AP, Wetterslev M, Hansen SE, et al. Postoperative pain treatment after total knee arthroplasty: A systematic review. PLoS One 2017; 12(3):e0173107.
9. Thybo KH, Hägi-Pedersen D, Dahl JB, et al. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. Jama 2019; 321(6):562-571.
10. Gasbjerg KS, Hägi-Pedersen D, Lunn TH, Laursen CC, Holmqvist M, Vinstrup LØ, Ammitzboell M, Jakobsen K, Jensen MS, Pallesen MJ, Bagger J, Lindholm P, Pedersen NA, Schrøder HM, Lindberg-Larsen M, Nørskov AK, Thybo KH, Brorson S, Overgaard S, Jakobsen JC, Mathiesen O. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ. 2022 Jan 4;376:e067325. doi: 10.1136/bmj-2021-067325. PMID: 34983775; PMCID: PMC8724786.
11. Thybo KH, Hägi-Pedersen D, Dahl JB, Wetterslev J, Nersesjan M, Jakobsen JC, Pedersen NA, Overgaard S, Schrøder HM, Schmidt H, Bjørck JG, Skovmand K, Frederiksen R, Buus-Nielsen M, Sørensen CV, Kruuse LS, Lindholm P, Mathiesen O. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):562-571. doi: 10.1001/jama.2018.22039. PMID: 30747964; PMCID: PMC6439592.
