I. What is “Rapid Rehabilitation Surgery”?
”Rapid Recovery Surgery” was first introduced by Professor Henrik in Denmark in 1997, and has since been promoted and applied to other surgical fields such as general urology, and now to joint surgery.
”Rapid Recovery Surgery” is both a concept and a technique that optimizes surgical skills and perioperative management to provide patients with a greater sense of well-being, including the safest treatment, the best surgical outcome, the fastest recovery, and the most satisfying experience and quality of life. Improving patient satisfaction is one of the ultimate goals of “Rapid Rehabilitation Surgery”.
Second, how should the medical and nursing staff do?
1. Do health education: inform patients and their families what kind of surgery is artificial knee replacement surgery; what preparations should be made before surgery, such as blowing up balloons, active coughing, maintaining the original level of walking and exercise to maintain and enhance cardiopulmonary function, and insisting on functional exercise of the quadriceps muscle; inform patients what may happen after surgery and what measures should be taken to avoid these adverse reactions.
2. Pre-operative assessment of the patient’s general condition: understanding the patient’s current overall health level, whether other diseases coexist, how the medication is used, whether the medication regimen needs to be adjusted, whether the surgery can be tolerated, and whether other organ functions need to be optimized.
3. Choice of anesthesia: The anesthesiologist makes a precise choice of anesthesia according to the individual patient’s condition. Both the exact anesthetic effect and possible adverse effects such as nausea, vomiting and weakening of muscle strength after nerve block should be avoided as much as possible.
4.Multi-modal analgesic scheme development and optimal sleep management: both preoperative analgesia in advance and personalized postoperative analgesic scheme should be given according to the different conditions of patients, and if there is sleep disorder, an effective sleep scheme selection should be made.
5.Optimize the application of tourniquet: limited tourniquet use, use low-pressure tourniquet only for bone cement fixation to avoid damage to tissues as much as possible.
6.Optimize surgical operation skills: including the selection of incision and prosthesis, follow RTTS (Reduced Tissue Trauma Surgery) operation concept throughout the surgery, and also have precise osteotomy and excellent soft tissue balancing techniques.
7.Optimize blood management: preoperative anemia exists and should be treated; intraoperative tranexamic acid is used and minimally invasive operation is performed; postoperative ice packs and moderate pressure bandages are applied to reduce bleeding and blood transfusion.
8.Optimize drainage tube and urinary catheter management: the urinary catheter and drainage tube should be set off on the first postoperative day, support walker to move on the ground, and some patients do not keep drainage tube.
9. Prevention of infection: it should be carried out throughout the treatment. There should be no potential sources of infection before surgery, such as gum inflammation, urethritis and foot fungus, etc., and if they exist, they should be treated accordingly; strict aseptic operation during surgery; and prophylactic use of antibiotics after surgery.
10, wound management: from the beginning of the surgical operation to protect the tissues, after surgery suturing, pay attention to the suturing technique of the incision, as well as the postoperative drug exchange process need to pay attention to.
11. Development of rehabilitation plan: from the time of returning to the ward to the time of discharge, different rehabilitation plans are developed at different stages: exercise of quadriceps, application of ankle pump, knee flexion and extension, walking with walkers, walking with walkers, going up and down stairs, squatting and standing, fall prevention, etc.
Third, what do patients and families need to do?
1. Understand the general procedure of surgery, what preparations should be made before surgery, how to do rehabilitation after surgery, actively participate in the treatment and rehabilitation process, and have clearer expectations of the stage of treatment results.
2. Inform the medical staff and anesthesiologists what their current level of health status is, what is the history of previous diseases, what are the current coexisting diseases, drug use and some special family history.
3. Adjust the patient’s nutritional level to the optimal state.
4.Actively do prehabilitation, which is what we call “Prerehabilitation”. To enhance and exercise the cardiopulmonary function, especially the quadriceps function exercise.
5, to understand what complications may occur during the treatment and rehabilitation process, and take active measures to avoid these complications.
6, after discharge from the hospital to continue to maintain communication and contact with the medical staff, the rehabilitation treatment to continue, if abnormalities appear, timely return to the hospital treatment.
7. Patients should be accompanied by their family members throughout the treatment and rehabilitation, not only for physical help, but more importantly for psychological and spiritual support, encouragement and care, so that patients can have a more relaxed and pleasant medical experience.