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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 i.v.
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 vurdere 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
Celecoxib 200 mg x 2 PO i 3 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 7 dage (hofte) / 14 dage (knæ)
Antiemetika efter regional rekommandation
Laksantia efter regional rekommandation

 

Referencer

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.