Perioperative management
thrombosis, nausea, pneumonia, hyperalgesia, Postoperative pain, PostOperative Nausea and Vomiting, pain, PONV
THROMBOSIS, PNEUMONIA, PULMONARY EMBOLISM, DEEP VEIN THROMBOSIS
All surgeries were conducted by senior orthopedic surgeons in a class-100 laminar flow operating theatre, employing either general or epidural anesthesia with a posterolateral surgical approach. The hip prostheses implanted were all uncemented and we did not place any drainage catheters.Postoperatively, the patients were transferred to the post-anesthetic recovery room, and the surgical site was padded routinely upon their return to the inpatient ward. We initiated intermittent orthopedic limb compression therapy until the patients commenced functional out-of-bed exercises. Guided by a rehabilitation therapist, all patients engaged in daily functional and walking exercises. Our strategy for managing pain and PostOperative Nausea and Vomiting (PONV) involved administering preoperative oral diclofenac sodium (100 mg tid) for hyperalgesia. Postoperative pain was evaluated using a 0–10 Visual Analogue Scale (VAS), with intramuscular tramadol (100 mg qd or bid) added when VAS exceeded 4. For severe pain (VAS > 6), intramuscular meperidine hydrochloride (100 mg qd) was given. Metoclopramide (10 mg intramuscularly) was employed as the first-line treatment for severe nausea (VAS > 4) or two or more episodes of PONV. All patients were prescribed subcutaneous naltrexone heparin calcium (0.3 mL, 2850 IU), with subsequent full doses given at 24-h intervals. Post-discharge, we administered rivaroxaban (10 mg orally qd) for 10 days to mitigate the risk of deep vein thrombosis of the lower extremities. Regular Doppler ultrasound and CT scans were used to detect thrombosis in the deep veins of the lower extremities and diagnose pneumonia or pulmonary embolism, respectively.