Enhanced Recovery Protocol Reduces Transfusion Requirements and Hospital Stay in Patients Undergoing an Elective Arthroplasty Procedure

Table 1

Traditional protocol versus enhanced recovery protocol.

	Traditional protocol	Enhanced recovery protocol
Preoperative	(i) Generic patient education	(i) Patient education and emphasis on active patient participation—“joint school”; (ii) Energy drink 2 hrs before surgery; (iii) Premedication: omeprazole 20 mg PO and gabapentin 300 mg PO
Perioperative	(i) General or spinal anaesthesia according to anaesthetist’s preferences	(i) Spinal anaesthesia: 3 mL of 0.5% levobupivacaine; (ii) Antibiotics: 1.2 g co-amoxiclav; (iii) Tranexamic acid 1 g IV; (iv) Medication: Paracetamol 1g IV, Ondansetron 4 mg IV, Dexamethasone 6.6 mg IV; (v) Local infiltration: 100 mL of 0.2% ropivacaine with 1 in 100000 adrenaline and 50 mLs of plain 0.2% ropivacaine for skin and subcutaneous tissues
Postoperative	(i) Enoxaparin 48 hrs after surgery; (ii) Analgesia and fluid management according to consultants preferences; (iii) Involving femoral/sciatic nerve blocks and PCAs for all patients; (iv) Physiotherapy without a specific postoperative protocol—mobilised when nerve blocks wear off at variable duration	(i) Enoxaparin started the same day; (ii) Multimodal analgesia management by acute pain team and ward staff using oxycodone regime. No PCA/nerve blocks; (iii) Fluid monitoring; (iv) Early mobilisation with physiotherapy—the same day or early next day