45 year male suffered a road traffic accident, his pelvic fracture operated. What are most important post operative management principles are to be followed?
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Hello, 45 year male suffered a road traffic accident, his pelvic fracture operated. What are most important post operative management principles are to be followed? Please leave your comments.
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@nipa Postoperative pain control is important for enhancing patient mobilization. Epidural narcotics provide excellent pain relief in the acute postoperative period; however, one must be aware of potential epidural bleeding with concurrent anticoagulation. Patient-controlled analgesia (PCA) machines work well to alleviate postoperative pain, and patients do not depend on nursing administration of narcotic analgesics. Long-acting oral narcotic medications may be useful as an adjunct to PCA to provide sustained pain control. After discontinuance of intravenous narcotic medications, both long-acting and short-acting oral narcotics are used to manage postoperative pain. DVT prophylaxis is important postoperatively and should be managed aggressively. Mechanical methods, such as support stockings, work to decrease venous stasis, thereby decreasing the risk of DVT formation. Sequential compression devices also work to decrease venous stasis, but they also may have a role in stimulating the fibrinolytic system and tissue factor pathway inhibitor release. Pharmacologic DVT prophylaxis consists of subcutaneous heparin, LMWH, warfarin, and aspirin. The choice of agent is beyond the scope of this discussion, but evidence suggests that combined mechanical and pharmacologic prophylaxis may result in greater protection than either preventive measure alone. IVC filters may be placed perioperatively in patients in whom pharmacologic DVT prophylaxis and treatment are contraindicated and also in patients with documented DVTs.