Der Orthopäde
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The expected cost explosion in transfusion medicine increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance represents an integral part of any blood conservation concept. ⋯ Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.
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Review Comparative Study
[The value of regional and general anaesthesia in orthopaedic surgery].
Adequate postoperative pain management is of major importance for a short rehabilitation time after painful orthopaedic surgery. Multimodal pathways have been established to achieve a surgical patient free of pain and complications. Peripheral and central nerve blocks are a fundamental part of these interdisciplinary strategies and are already implemented in orthopaedic surgical care. This article summarises the value of special anaesthetic techniques, especially regional anaesthesia, in orthopaedic surgery and discusses their impact on several postoperative outcome goals.
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Review Comparative Study
[Foreign blood saving measures in orthopedic surgery].
Major transfusion-free orthopaedic surgery can be performed successfully. This requires advanced planning, good routines and close collaborative team efforts. ⋯ For various reasons, we do not recommend the transfusion of wound drainage. This article describes the various methods for bloodless medical care.
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Under-treatment of acute postoperative pain can lead to chronic pain with neuronal plasticity and result in poor surgical outcomes. A multimodal approach is therefore necessary to reduce postoperative pain by combining various analgesics with a non-pharmacological strategy. ⋯ Adequate pain control is an important prerequisite for the application of rehabilitation programmes and will thereby influence functional outcome. In addition, patient satisfaction, as a major benchmarking factor after surgical treatment, is significantly influenced by the quality of postoperative pain management.