Operative stage | Fast track | Standard care |
---|---|---|
Preoperative | Comprehensive patient education - 1-h lesson - Multimedia material (images, animation, and video) - Patient personal summary booklet | Standard patient education - 15-min lesson |
Intraoperative | - Minimally invasive surgery - Subarachnoid anesthesia - Tranexamic acid | - Minimally invasive surgery - Subarachnoid anesthesia - Tranexamic acid |
Pain management | 2 h before surgery: - 1 tablet of 1000 mg paracetamol - 1 tablet of 600 mg gabapentin - 1 tablet of 200 mg celecoxib | |
4 h after surgery: - 1 tablet of 1000 mg paracetamol - 1 tablet of 300 mg gabapentin Before sleeping: - 1 tablet of 10 mg oxycodone or 1 tablet of 100 mg tapentadol The first postoperative day: - 1 tablet of 1000 mg paracetamol every 6 h - 1 tablet of 30 mg celecoxib at 8.00 a.m. - 1 tablet of 300 mg gabapentin at 9.00 a.m. From the second postoperative day up to a maximum of 15 days: - 1 tablet of 1000 mg paracetamol every 12 h - 1 tablet of 200 mg celecoxib at 8.00 a.m. | Every 8 h after surgery - 30 mg ketorolac and 100 mg tramadol in 100 mL of physiologic saline solution Severe pain management - 1 tablet of oxycodone hydrochloride (5 or 10 mg) is administered every 12 h | |
(Rescue dose): - 1 tablet of 500 mg paracetamol - 1 tablet of 30 mg codeine phosphate (this dose should be repeated after 12 h) | (Rescue dose): - Intravenous 1000 mg paracetamol every 8 h | |
Rehabilitation | Intensive rehabilitation protocol Day 0 (t1): - In the morning: surgical operation Day 0 (t1), in the afternoon: - Resuming verticalization - Walking with the help of physiotherapists and a front-wheel walker | Standard rehabilitation protocol Day 0 (t1): - In the morning: surgical operation |
Day 1 (t2): - Mobilization in bed - Attempt to use crutches - Stair climbing with crutches (if tolerated) - Physiotherapy is performed two times a day | Day 1 (t2), in the morning: - Mobilization in bed Day 1 (t2), in the afternoon: - Resuming the vertical position - Walking with the help of physiotherapists and a front-wheel walker | |
Day 2 (t3): - Verification and control of functional acquisitions of the patient - Weaning from a crutch - Physiotherapy twice daily | Day 2 (t3): - Physiotherapy is performed twice a day using first the walker then the crutches | |
Day 3 (t4): - Weight-bearing gradual resumption - Patient discharge | Days 3, 4 (t4, t5): - Stair climbing with crutches - Weaning from a crutch | |
Days 5–7 (t6): - Weight-bearing gradual resumption - Patient discharge |