Yoeri Bemelmans

Chapter 4 48 Multidisciplinary enhanced clinical pathway The following pathway applies to both groups. A personal coach was involved as much as possible to inspire, correct and support the patient while in hospital and directly after discharge. In addition, the coach also indirectly reduces the workload on the nursery in terms of helpingwith all-day activities. All patients received preoperative education and exercise training, to become familiar with walking (stairs) with crutches and transfers from bed to a chair and vice versa, information about the in- and outpatient pro-cess and home-based rehabilitation. The first mobilizationwas attempted<6 h postoperative including transfer from a bed to a chair and vice versa following walking with a walker if possible under supervision of a physiotherapist and nurse. All patients were familiar with the overall dis-charge criteria: mobilize and transfer into and out of bed individual and safe, able to get into and up from a chair, walk independently with crutches and if necessary walk-ing stairs with crutches. After discharge, physiotherapy in their home environment was started 14 days postoperative. All patients were seen at the outpatient clinic at 2, 6 and 12 weeks postoperative. Table 1. Multimodal opioid sparing pain protocol was provided. Preoperative Postoperative 2h 4h 8h First day Day 2-14 Arcoxia (mg) 90 90 90 Paracetamol (g) 1 1 1 1* 1* Gabapentin (mg) 600 300 300 Omeprazol (mg) 40 40 40 *Paracetamol (1g) was given four times daily on fixed intervals throughout the day. Randomization and blinding To make sure LIA medication was blinded to the patients, orthopaedic surgeon, investigator and other persons direct and indirect involved in the study, randomization and prep-aration of the syringes for both ropivacaine with (Ropi+) and without adrenaline (Ropi−), were performed by the hospital pharmacist (HK). Randomization was performed using computer, web-based generated randomized num-bers (www. random.org ). Three syringes (50 ml each) were numbered from one to three, whereas syringe one and two contained ropivacaine (2 %) with or without adrenaline (0.01 %) and the third syringe was always without adrena-line. Randomization was unblinded after study completion or in case of a suspected unexpected serious adverse reac-tion (SUSAR).