SlideShare a Scribd company logo

Short Stay Knee Arthroplasty

•Download as PPTX, PDF•
•
Edward R. Mariano, MD
Edward R. Mariano, MD

For this #RAUK21 clinical symposium presentation, I present anesthesia and pain management considerations for short-stay knee arthroplasty including patient selection criteria, intraoperative anesthetic technique, multimodal analgesia, and nerve block options.

Health & Medicine
1 of 16
Short-stay knee arthroplasty Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System @EMARIANOMD
@EMARIANOMD Disclosures  None
@EMARIANOMD Kurtz S, et al. JBJS 2007 Arthroplasties are increasing
@EMARIANOMD Arthroplasties are expensive
@EMARIANOMD Short-stay may cut costs Tse et al. J Anesth 2017
@EMARIANOMD Same-day knee arthroplasty cost controversy
@EMARIANOMD
@EMARIANOMD
@EMARIANOMD Is our patient a candidate?
@EMARIANOMD
@EMARIANOMD Memtsoudis, et al. BJA 2019
@EMARIANOMD Recommendations Memtsoudis, et al. BJA 2019 • Neuraxial anaesthesia is an “opioid-free” option • No neuraxial opioids in our practice
@EMARIANOMD Start with multimodal analgesia Class Mechanism of Action Options Frequency Considerations Nonpharmacologic Variable Patient Education Compression Cryotherapy Acupuncture Electrical Stimulation Routine No clear guidelines NSAIDs Nonselective COX-1,2 inhibition Selective COX-2 inhibition Ketorolac Ibuprofen Celecoxib Routine Renal insufficiency, gastric ulcers, platelet dysfunction, cardiovascular disease Acetaminophen Central prostaglandin synthesis inhibition Acetaminophen (Paracetamol) Routine Hepatic dysfunction Gabapentinoids Binding to alpha-2-delta subunits of voltage- dependent calcium channels Gabapentin Pregabalin If indicated Renal impairment NMDA Antagonists N-methyl-D-aspartate blockade Ketamine Magnesium If indicated Severe psychiatric disorders, raised intracranial or intraocular pressure (ketamine only) Local and Regional Analgesia Sodium channel blockade Spinal/Epidural Lumbar Plexus ± Sacral Plexus Femoral Nerve ± Sciatic Nerve Femoral Nerve ± LIA Adductor Canal ± LIA Adductor Canal ± IPACK LIA Only Routine Allergy to local anesthetic, site infection, available resources and training level of staff NSAIDs = nonsteroidal anti-inflammatory drugs; NMDA = N-methyl-D-aspartate; LIA = local infiltration analgesia; IPACK = infiltration between the popliteal artery and capsule of the knee Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019
@EMARIANOMD
@EMARIANOMD So many options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019 or genicular nerve blocks or genicular nerve blocks
@EMARIANOMD So many options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019 or genicular nerve blocks or genicular nerve blocks

Recommended

Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Edward R. Mariano, MD
 
The Biggest Threats to Anesthesiology Are...
The Biggest Threats to Anesthesiology Are...The Biggest Threats to Anesthesiology Are...
The Biggest Threats to Anesthesiology Are...
Edward R. Mariano, MD
 
The Joint Replacement Bundle: Implications for Patients and Acute Pain Services
The Joint Replacement Bundle: Implications for Patients and Acute Pain ServicesThe Joint Replacement Bundle: Implications for Patients and Acute Pain Services
The Joint Replacement Bundle: Implications for Patients and Acute Pain Services
Edward R. Mariano, MD
 
Multimodal analgesia and opioids after hip surgery
Multimodal analgesia and opioids after hip surgeryMultimodal analgesia and opioids after hip surgery
Multimodal analgesia and opioids after hip surgery
Edward R. Mariano, MD
 
The Evolution of Training in Regional Anaesthesia
The Evolution of Training in Regional AnaesthesiaThe Evolution of Training in Regional Anaesthesia
The Evolution of Training in Regional Anaesthesia
Edward R. Mariano, MD
 
How Does Regional Anesthesia Stay Relevant in the Future?
How Does Regional Anesthesia Stay Relevant in the Future?How Does Regional Anesthesia Stay Relevant in the Future?
How Does Regional Anesthesia Stay Relevant in the Future?
Edward R. Mariano, MD
 
Interfascial Plane Blocks: Should We Believe the Hype?
Interfascial Plane Blocks: Should We Believe the Hype?Interfascial Plane Blocks: Should We Believe the Hype?
Interfascial Plane Blocks: Should We Believe the Hype?
Edward R. Mariano, MD
 
How Regional Anesthesia Can Improve Outcomes that Matter
How Regional Anesthesia Can Improve Outcomes that MatterHow Regional Anesthesia Can Improve Outcomes that Matter
How Regional Anesthesia Can Improve Outcomes that Matter
Edward R. Mariano, MD
 

Recommended

Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Interfascial Plane Blocks Offer an Acceptable Alternative to Thoracic Epidura...
Edward R. Mariano, MD
 
The Biggest Threats to Anesthesiology Are...
The Biggest Threats to Anesthesiology Are...The Biggest Threats to Anesthesiology Are...
The Biggest Threats to Anesthesiology Are...
Edward R. Mariano, MD
 
The Joint Replacement Bundle: Implications for Patients and Acute Pain Services
The Joint Replacement Bundle: Implications for Patients and Acute Pain ServicesThe Joint Replacement Bundle: Implications for Patients and Acute Pain Services
The Joint Replacement Bundle: Implications for Patients and Acute Pain Services
Edward R. Mariano, MD
 
Multimodal analgesia and opioids after hip surgery
Multimodal analgesia and opioids after hip surgeryMultimodal analgesia and opioids after hip surgery
Multimodal analgesia and opioids after hip surgery
Edward R. Mariano, MD
 
The Evolution of Training in Regional Anaesthesia
The Evolution of Training in Regional AnaesthesiaThe Evolution of Training in Regional Anaesthesia
The Evolution of Training in Regional Anaesthesia
Edward R. Mariano, MD
 
How Does Regional Anesthesia Stay Relevant in the Future?
How Does Regional Anesthesia Stay Relevant in the Future?How Does Regional Anesthesia Stay Relevant in the Future?
How Does Regional Anesthesia Stay Relevant in the Future?
Edward R. Mariano, MD
 
Interfascial Plane Blocks: Should We Believe the Hype?
Interfascial Plane Blocks: Should We Believe the Hype?Interfascial Plane Blocks: Should We Believe the Hype?
Interfascial Plane Blocks: Should We Believe the Hype?
Edward R. Mariano, MD
 
How Regional Anesthesia Can Improve Outcomes that Matter
How Regional Anesthesia Can Improve Outcomes that MatterHow Regional Anesthesia Can Improve Outcomes that Matter
How Regional Anesthesia Can Improve Outcomes that Matter
Edward R. Mariano, MD
 
Dealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy ResearchersDealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy Researchers
Edward R. Mariano, MD
 
Pain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical CarePain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical Care
Edward R. Mariano, MD
 
Designing the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee ReplacementDesigning the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee Replacement
Edward R. Mariano, MD
 
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal SurgeryThoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Edward R. Mariano, MD
 
Technology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional AnesthesiaTechnology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional Anesthesia
Edward R. Mariano, MD
 
The Role of Social Media in Modern Medicine
The Role of Social Media in Modern MedicineThe Role of Social Media in Modern Medicine
The Role of Social Media in Modern Medicine
Edward R. Mariano, MD
 
Demonstrating Value in Regional Anesthesia
Demonstrating Value in Regional AnesthesiaDemonstrating Value in Regional Anesthesia
Demonstrating Value in Regional Anesthesia
Edward R. Mariano, MD
 
The Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and EvidenceThe Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and Evidence
Edward R. Mariano, MD
 
Regional Anesthesia Education and Social Media
Regional Anesthesia Education and Social MediaRegional Anesthesia Education and Social Media
Regional Anesthesia Education and Social Media
Edward R. Mariano, MD
 
Coaching and Developing Employees
Coaching and Developing EmployeesCoaching and Developing Employees
Coaching and Developing Employees
Edward R. Mariano, MD
 
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD OcclusionUsing EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Scintica Instrumentation
 
Shoulder replacement-surgery
Shoulder replacement-surgeryShoulder replacement-surgery
Shoulder replacement-surgery
SoulderPain
 
Why Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and LeadWhy Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and Lead
Edward R. Mariano, MD
 
Prediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRIPrediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRI
Wenjay Sung
 
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case StudyIRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET Journal
 
Zetroz universities in use
Zetroz universities in useZetroz universities in use
Zetroz universities in use
Nashville Fitness Supply
 
Designing Wildlife Migration Maps
Designing Wildlife Migration MapsDesigning Wildlife Migration Maps
Designing Wildlife Migration Maps
nacis_slides
 
Ijoro femur paper
Ijoro femur paper Ijoro femur paper
Ijoro femur paper
Dr.Avinash Rao Gundavarapu
 
Geriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-managementGeriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-management
Arun Shanbhag
 
Lessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid EpidemicLessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid Epidemic
Edward R. Mariano, MD
 
Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...
Indian dental academy
 
Resume_Dr. Manjoo
Resume_Dr. ManjooResume_Dr. Manjoo
Resume_Dr. ManjooAjay Manjoo MD FRCSC MSc
 

More Related Content

What's hot

Dealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy ResearchersDealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy Researchers
Edward R. Mariano, MD
 
Pain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical CarePain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical Care
Edward R. Mariano, MD
 
Designing the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee ReplacementDesigning the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee Replacement
Edward R. Mariano, MD
 
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal SurgeryThoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Edward R. Mariano, MD
 
Technology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional AnesthesiaTechnology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional Anesthesia
Edward R. Mariano, MD
 
The Role of Social Media in Modern Medicine
The Role of Social Media in Modern MedicineThe Role of Social Media in Modern Medicine
The Role of Social Media in Modern Medicine
Edward R. Mariano, MD
 
Demonstrating Value in Regional Anesthesia
Demonstrating Value in Regional AnesthesiaDemonstrating Value in Regional Anesthesia
Demonstrating Value in Regional Anesthesia
Edward R. Mariano, MD
 
The Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and EvidenceThe Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and Evidence
Edward R. Mariano, MD
 
Regional Anesthesia Education and Social Media
Regional Anesthesia Education and Social MediaRegional Anesthesia Education and Social Media
Regional Anesthesia Education and Social Media
Edward R. Mariano, MD
 
Coaching and Developing Employees
Coaching and Developing EmployeesCoaching and Developing Employees
Coaching and Developing Employees
Edward R. Mariano, MD
 
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD OcclusionUsing EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Scintica Instrumentation
 
Shoulder replacement-surgery
Shoulder replacement-surgeryShoulder replacement-surgery
Shoulder replacement-surgery
SoulderPain
 
Why Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and LeadWhy Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and Lead
Edward R. Mariano, MD
 
Prediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRIPrediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRI
Wenjay Sung
 
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case StudyIRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET Journal
 
Zetroz universities in use
Zetroz universities in useZetroz universities in use
Zetroz universities in use
Nashville Fitness Supply
 
Designing Wildlife Migration Maps
Designing Wildlife Migration MapsDesigning Wildlife Migration Maps
Designing Wildlife Migration Maps
nacis_slides
 
Ijoro femur paper
Ijoro femur paper Ijoro femur paper
Ijoro femur paper
Dr.Avinash Rao Gundavarapu
 

What's hot (18)

Dealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy ResearchersDealing with the Information Firehose: Tips for Busy Researchers
Dealing with the Information Firehose: Tips for Busy Researchers
 
Pain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical CarePain Medicine and the Pathway to Better Surgical Care
Pain Medicine and the Pathway to Better Surgical Care
 
Designing the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee ReplacementDesigning the "Best" Pain Management Plan for Knee Replacement
Designing the "Best" Pain Management Plan for Knee Replacement
 
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal SurgeryThoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
Thoracic Epidural Analgesia is the Gold Standard for Major Abdominal Surgery
 
Technology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional AnesthesiaTechnology for Teaching and Learning Regional Anesthesia
Technology for Teaching and Learning Regional Anesthesia
 
The Role of Social Media in Modern Medicine
The Role of Social Media in Modern MedicineThe Role of Social Media in Modern Medicine
The Role of Social Media in Modern Medicine
 
Demonstrating Value in Regional Anesthesia
Demonstrating Value in Regional AnesthesiaDemonstrating Value in Regional Anesthesia
Demonstrating Value in Regional Anesthesia
 
The Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and EvidenceThe Quest for Longer Block Duration: Techniques and Evidence
The Quest for Longer Block Duration: Techniques and Evidence
 
Regional Anesthesia Education and Social Media
Regional Anesthesia Education and Social MediaRegional Anesthesia Education and Social Media
Regional Anesthesia Education and Social Media
 
Coaching and Developing Employees
Coaching and Developing EmployeesCoaching and Developing Employees
Coaching and Developing Employees
 
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD OcclusionUsing EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
Using EKG to Confirm MI in Mouse Model of Permanent LAD Occlusion
 
Shoulder replacement-surgery
Shoulder replacement-surgeryShoulder replacement-surgery
Shoulder replacement-surgery
 
Why Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and LeadWhy Physicians Should Speak Up and Lead
Why Physicians Should Speak Up and Lead
 
Prediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRIPrediction of Plantar Plate Injury using MRI
Prediction of Plantar Plate Injury using MRI
 
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case StudyIRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
IRJET- Calcaneal Apophysitis (Sever’s Disease) - A Case Study
 
Zetroz universities in use
Zetroz universities in useZetroz universities in use
Zetroz universities in use
 
Designing Wildlife Migration Maps
Designing Wildlife Migration MapsDesigning Wildlife Migration Maps
Designing Wildlife Migration Maps
 
Ijoro femur paper
Ijoro femur paper Ijoro femur paper
Ijoro femur paper
 

Similar to Short Stay Knee Arthroplasty

Geriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-managementGeriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-management
Arun Shanbhag
 
Lessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid EpidemicLessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid Epidemic
Edward R. Mariano, MD
 
Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...
Indian dental academy
 
How to Be a Leader in Anesthesiology and Beyond
How to Be a Leader in Anesthesiology and BeyondHow to Be a Leader in Anesthesiology and Beyond
How to Be a Leader in Anesthesiology and Beyond
Edward R. Mariano, MD
 
Controversies in periodontics
Controversies in periodonticsControversies in periodontics
Controversies in periodontics
R Viswa Chandra
 
Treatment Decisions in Osteoarthritis
Treatment Decisions in OsteoarthritisTreatment Decisions in Osteoarthritis
Treatment Decisions in Osteoarthritis
Sidney Erwin Manahan
 
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...Lisa Pilato
 
Hassan nawazish
Hassan nawazishHassan nawazish
Hassan nawazish
HassanNawazish
 
Selection of patient for intraoral implants / orthodontics training courses
Selection of patient for intraoral implants / orthodontics training coursesSelection of patient for intraoral implants / orthodontics training courses
Selection of patient for intraoral implants / orthodontics training courses
Indian dental academy
 
Selection of anterior teeths./ fixed orthodontics courses
Selection of anterior teeths./ fixed orthodontics coursesSelection of anterior teeths./ fixed orthodontics courses
Selection of anterior teeths./ fixed orthodontics courses
Indian dental academy
 
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)Bác Sĩ Aibolit
 
2 systemic disorders and Prostho management.pptx
2 systemic disorders and Prostho management.pptx2 systemic disorders and Prostho management.pptx
2 systemic disorders and Prostho management.pptx
DrAyshaSadaf
 
Goodman et al-2017-arthritis_&_rheumatology
Goodman et al-2017-arthritis_&_rheumatologyGoodman et al-2017-arthritis_&_rheumatology
Goodman et al-2017-arthritis_&_rheumatology
Virginia Mason Internal Medicine Residency
 
2 systemic disorders.pptx
2 systemic disorders.pptx2 systemic disorders.pptx
2 systemic disorders.pptx
DrAyshaSadaf
 
Ilizarov
IlizarovIlizarov
Ilizarov
Sunshine Hospitalz
 
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
Indian dental academy
 

Similar to Short Stay Knee Arthroplasty (20)

Geriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-managementGeriatric Fracture Patient Co-management
Geriatric Fracture Patient Co-management
 
Lessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid EpidemicLessons Learned from the U.S. Opioid Epidemic
Lessons Learned from the U.S. Opioid Epidemic
 
Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...Selection of dental implant patients /certified fixed orthodontic courses by ...
Selection of dental implant patients /certified fixed orthodontic courses by ...
 
Resume_Dr. Manjoo
Resume_Dr. ManjooResume_Dr. Manjoo
Resume_Dr. Manjoo
 
How to Be a Leader in Anesthesiology and Beyond
How to Be a Leader in Anesthesiology and BeyondHow to Be a Leader in Anesthesiology and Beyond
How to Be a Leader in Anesthesiology and Beyond
 
Protect Your Heart And Save You Life By
Protect Your Heart And Save You Life ByProtect Your Heart And Save You Life By
Protect Your Heart And Save You Life By
 
Protect Your Heart And Save You Life By
Protect Your Heart And Save You Life ByProtect Your Heart And Save You Life By
Protect Your Heart And Save You Life By
 
Protect Your Heart And Save You Life By
Protect Your Heart And Save You Life ByProtect Your Heart And Save You Life By
Protect Your Heart And Save You Life By
 
Controversies in periodontics
Controversies in periodonticsControversies in periodontics
Controversies in periodontics
 
Treatment Decisions in Osteoarthritis
Treatment Decisions in OsteoarthritisTreatment Decisions in Osteoarthritis
Treatment Decisions in Osteoarthritis
 
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...
Ortho ob my knee arthritis is killing me but i dont want surgery what can i d...
 
Hassan nawazish
Hassan nawazishHassan nawazish
Hassan nawazish
 
Selection of patient for intraoral implants / orthodontics training courses
Selection of patient for intraoral implants / orthodontics training coursesSelection of patient for intraoral implants / orthodontics training courses
Selection of patient for intraoral implants / orthodontics training courses
 
Selection of anterior teeths./ fixed orthodontics courses
Selection of anterior teeths./ fixed orthodontics coursesSelection of anterior teeths./ fixed orthodontics courses
Selection of anterior teeths./ fixed orthodontics courses
 
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)
[Jong suk, ph.d._lee,_jung_kook,_ph.d._kim,_young-(book_fi.org)
 
2 systemic disorders and Prostho management.pptx
2 systemic disorders and Prostho management.pptx2 systemic disorders and Prostho management.pptx
2 systemic disorders and Prostho management.pptx
 
Goodman et al-2017-arthritis_&_rheumatology
Goodman et al-2017-arthritis_&_rheumatologyGoodman et al-2017-arthritis_&_rheumatology
Goodman et al-2017-arthritis_&_rheumatology
 
2 systemic disorders.pptx
2 systemic disorders.pptx2 systemic disorders.pptx
2 systemic disorders.pptx
 
Ilizarov
IlizarovIlizarov
Ilizarov
 
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...
 

More from Edward R. Mariano, MD

Opioid-Free Anesthesia Is Not a Thing
Opioid-Free Anesthesia Is Not a ThingOpioid-Free Anesthesia Is Not a Thing
Opioid-Free Anesthesia Is Not a Thing
Edward R. Mariano, MD
 
Modernize Your CV with a Digital Portfolio
Modernize Your CV with a Digital PortfolioModernize Your CV with a Digital Portfolio
Modernize Your CV with a Digital Portfolio
Edward R. Mariano, MD
 
Considerations for Regional Anesthesia in the Trauma Patient
Considerations for Regional Anesthesia in the Trauma PatientConsiderations for Regional Anesthesia in the Trauma Patient
Considerations for Regional Anesthesia in the Trauma Patient
Edward R. Mariano, MD
 
Regional Anesthesia in the Prevention of Persistent Postsurgical Pain
Regional Anesthesia in the Prevention of Persistent Postsurgical PainRegional Anesthesia in the Prevention of Persistent Postsurgical Pain
Regional Anesthesia in the Prevention of Persistent Postsurgical Pain
Edward R. Mariano, MD
 
Twitter for Busy Doctors
Twitter for Busy DoctorsTwitter for Busy Doctors
Twitter for Busy Doctors
Edward R. Mariano, MD
 
Anesthesiology: Past, Present, and Future
Anesthesiology: Past, Present, and FutureAnesthesiology: Past, Present, and Future
Anesthesiology: Past, Present, and Future
Edward R. Mariano, MD
 
Management of the patient with suspected perioperative nerve injury
Management of the patient with suspected perioperative nerve injuryManagement of the patient with suspected perioperative nerve injury
Management of the patient with suspected perioperative nerve injury
Edward R. Mariano, MD
 
How to set up an acute pain service that adds value
How to set up an acute pain service that adds valueHow to set up an acute pain service that adds value
How to set up an acute pain service that adds value
Edward R. Mariano, MD
 
Update on continuous peripheral nerve block techniques
Update on continuous peripheral nerve block techniquesUpdate on continuous peripheral nerve block techniques
Update on continuous peripheral nerve block techniques
Edward R. Mariano, MD
 
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
Edward R. Mariano, MD
 
Regional anesthesia and perioperative outcomes
Regional anesthesia and perioperative outcomesRegional anesthesia and perioperative outcomes
Regional anesthesia and perioperative outcomes
Edward R. Mariano, MD
 

More from Edward R. Mariano, MD (11)

Opioid-Free Anesthesia Is Not a Thing
Opioid-Free Anesthesia Is Not a ThingOpioid-Free Anesthesia Is Not a Thing
Opioid-Free Anesthesia Is Not a Thing
 
Modernize Your CV with a Digital Portfolio
Modernize Your CV with a Digital PortfolioModernize Your CV with a Digital Portfolio
Modernize Your CV with a Digital Portfolio
 
Considerations for Regional Anesthesia in the Trauma Patient
Considerations for Regional Anesthesia in the Trauma PatientConsiderations for Regional Anesthesia in the Trauma Patient
Considerations for Regional Anesthesia in the Trauma Patient
 
Regional Anesthesia in the Prevention of Persistent Postsurgical Pain
Regional Anesthesia in the Prevention of Persistent Postsurgical PainRegional Anesthesia in the Prevention of Persistent Postsurgical Pain
Regional Anesthesia in the Prevention of Persistent Postsurgical Pain
 
Twitter for Busy Doctors
Twitter for Busy DoctorsTwitter for Busy Doctors
Twitter for Busy Doctors
 
Anesthesiology: Past, Present, and Future
Anesthesiology: Past, Present, and FutureAnesthesiology: Past, Present, and Future
Anesthesiology: Past, Present, and Future
 
Management of the patient with suspected perioperative nerve injury
Management of the patient with suspected perioperative nerve injuryManagement of the patient with suspected perioperative nerve injury
Management of the patient with suspected perioperative nerve injury
 
How to set up an acute pain service that adds value
How to set up an acute pain service that adds valueHow to set up an acute pain service that adds value
How to set up an acute pain service that adds value
 
Update on continuous peripheral nerve block techniques
Update on continuous peripheral nerve block techniquesUpdate on continuous peripheral nerve block techniques
Update on continuous peripheral nerve block techniques
 
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
Surface anatomy and sonoanatomy for the occasional regional anesthesiologist
 
Regional anesthesia and perioperative outcomes
Regional anesthesia and perioperative outcomesRegional anesthesia and perioperative outcomes
Regional anesthesia and perioperative outcomes
 

Recently uploaded

Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Sex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skullSex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skull
ShashankRoodkee
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawahOcular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
pal078100
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in IndiaTop 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
SwastikAyurveda
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
Gram Stain introduction, principle, Procedure
Gram Stain introduction, principle, ProcedureGram Stain introduction, principle, Procedure
Gram Stain introduction, principle, Procedure
Suraj Goswami
 
Pictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdfPictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdf
Dr. Rabia Inam Gandapore
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
Sapna Thakur
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Prof. Marcus Renato de Carvalho
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
SwisschemDerma
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Saeid Safari
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
SwastikAyurveda
 

Recently uploaded (20)

Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Sex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skullSex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skull
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawahOcular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in IndiaTop 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
Gram Stain introduction, principle, Procedure
Gram Stain introduction, principle, ProcedureGram Stain introduction, principle, Procedure
Gram Stain introduction, principle, Procedure
 
Pictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdfPictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdf
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
 

Short Stay Knee Arthroplasty

  • 1. Short-stay knee arthroplasty Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System @EMARIANOMD
  • 3. @EMARIANOMD Kurtz S, et al. JBJS 2007 Arthroplasties are increasing
  • 5. @EMARIANOMD Short-stay may cut costs Tse et al. J Anesth 2017
  • 12. @EMARIANOMD Recommendations Memtsoudis, et al. BJA 2019 • Neuraxial anaesthesia is an “opioid-free” option • No neuraxial opioids in our practice
  • 13. @EMARIANOMD Start with multimodal analgesia Class Mechanism of Action Options Frequency Considerations Nonpharmacologic Variable Patient Education Compression Cryotherapy Acupuncture Electrical Stimulation Routine No clear guidelines NSAIDs Nonselective COX-1,2 inhibition Selective COX-2 inhibition Ketorolac Ibuprofen Celecoxib Routine Renal insufficiency, gastric ulcers, platelet dysfunction, cardiovascular disease Acetaminophen Central prostaglandin synthesis inhibition Acetaminophen (Paracetamol) Routine Hepatic dysfunction Gabapentinoids Binding to alpha-2-delta subunits of voltage- dependent calcium channels Gabapentin Pregabalin If indicated Renal impairment NMDA Antagonists N-methyl-D-aspartate blockade Ketamine Magnesium If indicated Severe psychiatric disorders, raised intracranial or intraocular pressure (ketamine only) Local and Regional Analgesia Sodium channel blockade Spinal/Epidural Lumbar Plexus ± Sacral Plexus Femoral Nerve ± Sciatic Nerve Femoral Nerve ± LIA Adductor Canal ± LIA Adductor Canal ± IPACK LIA Only Routine Allergy to local anesthetic, site infection, available resources and training level of staff NSAIDs = nonsteroidal anti-inflammatory drugs; NMDA = N-methyl-D-aspartate; LIA = local infiltration analgesia; IPACK = infiltration between the popliteal artery and capsule of the knee Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019
  • 15. @EMARIANOMD So many options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019 or genicular nerve blocks or genicular nerve blocks
  • 16. @EMARIANOMD So many options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract 2019 or genicular nerve blocks or genicular nerve blocks