Mare Nostrum

Pre-op / Post-op Orthopaedics

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Pre-op / Post-op Orthopaedics

  • Type of procedure: joint replacement (hip/knee TKR/THA), spine surgery, ORIF, arthroscopy
  • Anticoagulation bridging: hold warfarin 5 days pre-op; DOAC 1-2 days; restart 12-24h post-op (LMWH bridge if high VTE risk + warfarin held)
  • VTE risk (ortho): THA/TKR = highest risk → LMWH + TED stocking mandatory หลัง op
  • Blood conservation: preoperative Hb target >10 g/dL สำหรับ major ortho; TXA ลด blood loss (ถ้า surgeon ให้ใช้)
  • Periprosthetic joint infection (PJI) prevention: ATB prophylaxis + sterile technique; DM control HbA1c <7% pre-elective

🕐 One-Day Orders

🔬 Investigation

  • CBC, BUN/Cr, electrolytes, glucose — pre-op baseline
  • PT/INR, aPTT, platelet — coagulation check
  • Blood group + crossmatch (T&S for arthroscopy; T&C 2 units for THA/TKR/ORIF femur)
  • HbA1c ถ้า DM — infection + wound healing risk
  • CXR, ECG ถ้าอายุ >45
  • MRSA screening swab ถ้า high-risk — nasal + groin swab

💊 Medication

  • NPO: solid food 8h, clear liquid 2h pre-op
  • Pre-op prophylactic ATB (60 min before incision):
    • Cefazolin 2 g IV — routine (covers MSSA + Strep)
    • MRSA carrier: + Vancomycin 1.5 g IV 2h before
    • Repeat Cefazolin if surgery >3h หรือ blood loss >1.5L
  • TXA (Tranexamic Acid) ถ้า surgeon order: 15 mg/kg IV pre-incision + 3h post (THA/TKR protocol)
  • TED stocking + pneumatic compression pre-op

🔁 Continuous Orders

🔬 Investigation

  • CBC day 1 post-op — Hb drop (acceptable 2-4 g/dL); transfuse ถ้า Hb <8 + symptomatic หรือ <7
  • Wound check daily — erythema, serous/haematoserous discharge
  • X-ray post-op day 1 — implant position confirmation
  • ถ้า fever day 3+: CBC + CRP + ESR (PJI work-up)

💊 Medication

  • VTE prophylaxis — MANDATORY หลัง THA/TKR:
    • Enoxaparin 40 mg SC OD — เริ่ม 12h post-op x 14 วัน (TKR) หรือ 28-35 วัน (THA)
    • หรือ Rivaroxaban 10 mg PO OD ถ้าใช้ DOAC
  • Multimodal analgesia (ERAS ortho):
    • Paracetamol 1g q6h + Celecoxib 200 mg BID (selective COX-2 — safe for bone healing)
    • Tramadol/Opioid PRN
  • Calcium 1000 mg + Vit D 800 IU OD — bone health
  • Early physiotherapy day 1 — ROM exercises + partial weight-bearing (per surgeon)

Graph View