February 9, 2021
Geriatric Orthopedic Hip Fracture ERAS
- Make this an ideal surgical experience for you, the patient.
- Incorporate a comprehensive pain regimen including behavioral techniques, medications, and a nerve block to improve your postoperative pain control while decreasing your narcotic needs.
- Prevent potential surgical and anesthesia complications.
- Reduce the amount of time you’re in the hospital after surgery.
- Decrease your likelihood of a future fracture and improve your overall function.
Prior to Surgery
- Your involvement with the program begins in the Emergency Department if your treatment plan includes surgical repair.
- We will treat your pain and prepare you for surgery.
- Patients will be scheduled for surgery as soon as they are medically ready. Our goal is for this to happen within 48 hours of your diagnosis.
- Your surgeon will meet with you to explain surgical plans and set your expectations.
- Preparations may include blood tests and other tests based on your existing medical conditions.
- A nerve block will likely be performed to decrease your pain and need for IV and oral pain medications.
- Additional pain medications will be given (such as acetaminophen, celecoxib, and others if necessary).
- On the night before surgery, do not eat solid foods after 11 p.m.
- You can drink up to 20 ounces of clear liquids (such as water or Gatorade) up to two hours before your surgery start time.
- You’ll be evaluated by your anesthesia team, which will include an anesthesiologist and possibly a nurse anesthetist. The anesthetic plan will be tailored to you with the goals of optimizing your safety, comfort, and early recovery.
- You and your anesthesiologist will choose whether you receive spinal or general anesthesia. Your anesthesia team will monitor you very closely throughout the surgery.
- You will receive multiple medications during surgery to treat pain and nausea.
- There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain control, and accelerate your recovery.
- A nerve block might be repeated before or after the procedure. This is designed to decrease your postoperative pain and need for IV and oral pain medications.
- The whole process, from the time you leave your hospital room until you return to it after surgery, typically takes four to five hours.
- After surgery, your care team will continue to help enhance your recovery through:
- Offering physical therapy, occupational therapy, or both, depending on your injury
- Optimizing your nutrition and diet
- Treating pain
- Addressing other medical conditions if you have them
- Mitigating the risk of post-surgery complications
- Determining what level of assistance you will need after discharge and where you should receive it
- We encourage you to get out of bed and sit in a chair for all of your meals. Please ask for help before getting up: “Call, don’t fall.”
- You'll wear compression boots or stockings that inflate and deflate mechanically. The massaging action helps prevent a blood clot.
- You'll also use an incentive spirometry device to help expand your lungs.
- During your recovery, our goal is to try to provide you with the best pain relief we can without using opioids, which can cause a number of side effects.
- If you need opioid medication to manage pain, your plan will include reducing the amount you take over time until you are able to stop taking them.
- To avoid delirium, which can be caused by many things during your illness and can be a side effect of opioids, stay connected with people, place, and time; keep your mind active; and keep a regular sleep schedule.
- You’ll learn more about bone health and how to potentially prevent more fractures.
- You’ll follow up with your surgeon after surgery and also our Bone Mineral Metabolism team.