In 2010, we started implementing the ACERTO project in a hospital in the northeast of the Brazilian Public Health (SUS) after five weeks with all stakeholders involved in the departments of Anesthesiology, Orthopedics, Geriatrics, Nutrition, Nursing, Physiotherapy, Psychology and Social Service. In the same way as in other hospitals, the implementation of fast track surgery was not obtained by all departments and all health professionals. The use of ACERTO protocol with clinical measures of accelerating patient recovery decreased length of stay, the number of suspensions of surgery, the need for ICU, the use of vesical catheter, the time of fasting, the time of oral food reintroduction, high earlier and faster return to family life, working as humanization of treatment to the elderly. Analgesia in all patients was obtained with local anesthetics through different plexus blocks with neurostimulator and no patient used spinal opioids. In medicine the vast majority is terribly attached to their arguments and no one is willing to give in to new truths. Dreaming costs nothing and the implementation of the ACERTO Project will cost nothing to any institution

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The lumbar plexus is located between the quadrates lumborum and the psoas major muscles. The aim of this study was to evaluate the efficacy of a single 0.25% of enantiomeric excess levobupivacaine (S75:R25) injection through the psoas compartment blockage in postoperative analgesia of patients undergoing hip orthopedic surgery. As the second objective was evaluated the presence of analgesia of the feet was also evaluated to determine whether there was dissemination to the sciatic nerve, and length of pre-operative fasting, presence of thirst and hunger in the operating room entrance, and the ability to receive net carbohydrate (CHO) after recovery from spinal block in the PACU. Methods: One hundred patients received lumbar plexus blockage at the psoas compartment through nerve stimulator and a 0.25% enantiomeric excess levobupivacaine 40-ml injection. Analgesia and pain severity were evaluated at 4, 8, 12, 16, 20 and 24 hours after surgery, similarly to rescue opioids. Results: The ilioinguinal, genitofemoral, lateral cutaneous of the thigh, femoral and obturator were blocked in 92% of patients in the first 8 hours. Sciatic nerve block assessed by foot analgesia was observed in 15 patients at 4 hours and 12 patients at 8 hours. Sciatic nerve block disappeared in all patients after 12 hours. Blockage has reduced the amount of postoperative opioids, and 40% of patients required no additional postoperative analgesia, with analgesia duration of approximately 19 hours. There were no clinical signs or symptoms of bupivacaine toxicity, as well as no sequels secondary to nerves blockage. The mean fasting time was less than 3 hours. This reflected that no patient complied of thirst or hunger to reach the operating room. Conclusions: This report shows that injections into psoas compartment space is easy to perform and provides an effective blockage of the five nerves. The lumbar plexus blockage at the psoas compartment can be recommended for use in postoperative analgesia after hip orthopedic surgeries.