Open Reduction Internal Fixation (ORIF) – Humerus

Anesthesia Implications

Position: Supine, one arm extended, one arm tucked, Bed turned 30 degrees
Time: 30-60 min (short)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: No
Lead: Yes

No tourniquet – The tourniquet’s proximity to the surgical site makes placement difficult or impossible. Usually it is left off. This implies risks for greater blood loss. The surgeon is also likely to request lower blood pressures to keep bleeding to a minimum.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.