The admittedly strong-armed tactic from orthopedic surgeon Randy G. Delcore, MD, to the anesthesiologists who practice at Cedar Orthopaedic Surgery Center came in 2013. “I essentially issued a mandate and said, ‘You’re not coming to my facility if you’re going to use narcotics,’” says Dr. Delcore, medical director of the facility in Cedar City, Utah, and a pioneer in the outpatient total joints movement who has been performing same-day knee and hip replacements since 2004.
The facility’s anesthesiologists, who were used to using opioids as a main ingredient in their pain control cocktails, got on board with the directive — and the results are impressive. In 2010, outpatient total joints patients at Cedar Orthopaedic received an average of nearly 60 morphine milligram equivalents and spent almost six hours in the PACU. Today, the morphine milligram equivalent is 9.5 per case and the average patient is standing up and getting dressed in 45 minutes, walking in about an hour and out of the PACU and on their way home in less than two hours.
That improvement and the steps the facility took to make it happen are why Cedar Orthopaedic Surgery Center is the winner of the 2022 OR Excellence Award for Pain Control. “Three simple directives drive our success: non-narcotic analgesia, fastidious intraoperative periarticular block placement and early mobilization,” says Dr. Delcore. “The most vital component of that trilogy is early mobility, and the other two components are the only way to facilitate it. The byproduct of doing all three well is efficient throughput.”