they will be given after procedures will be minimal.
The nurses then administer the first pre-op medica-
tion, generally a muscle relaxant that also acts as an
anti-anxiety medication.
At our medical center, a physical therapist meets
with patients an hour or two after surgery and gets
them up and walking immediately if appropriate, so
they don't become debilitated. After the physical
therapist assesses the patient to see what their
range of motion is and what their limitations are,
they're given a customized home exercise program
to follow, which starts with one or two physical
therapy sessions done virtually via telemedicine.
This is convenient for the patient because they
don't have to drive to and from appointments. They
can also start their physical therapy immediately,
which helps to make them functional faster. For
non-spinal procedures in which complications such
as limb swelling takes place, there are devices to
help. For total-knee replacements, for example, a
wristwatch-sized device worn at the knee stimu-
lates nerves to increase blood flow, reduce post-op
edema and prevent venous thromboembolism.
Standardize to succeed
One of the top reasons our orthopedic program is
so far ahead of the curve is that our anesthesia
team has been phenomenal about pushing the enve-
lope and receptive to collaborating with surgeons.
Multimodal anesthesia standardizes medication
types and amounts. This can insult some anesthesi-
ologists because it removes their ability to practice
"the art of medicine."
I truly believe, however, that medication prac-
tices need to be highly evidence-based, standard-
ized and precisely protocoled. Once anesthesia
teams realize multimodal protocols lead to a lack
of complications, they'll see everyone's interests
are mutually aligned and focused exactly where
they should be — on giving the patient a quick and
efficient road to recovery.
OSM
3 2 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 2 0
Dr. Singh (kern.singh@rushortho.com) is a
professor in the department of orthopaedic surgery
and founder of the Minimally Invasive Spine Study
Group at Rush University Medical Center in
Chicago, and the co-director of the Minimally
Invasive Spine Institute at Rush.
