Title:
Use of an ambulatory popliteal sciatic nerve catheter can facilitate day of surgery discharge for major foot and ankle arthrodesis
Author(s):
J. Tyrrell (1), O. Tweedie (1), N. Savva (2)
Institute(s):
(1) Anaesthetics, (2) Orthopaedics, Dorset County Hospital, Dorchester, UK
Introduction
Major foot and ankle arthrodeses are painful operations traditionally requiring extended inpatient admissions. We present results of a prospective audit demonstrating how an ambulatory popliteal sciatic nerve catheter, can facilitate day of surgery discharge.
Method
Patients received detailed written information regarding the nerve blocks including full risk-benefit profile.
Ultrasound-guided popliteal sciatic nerve catheter and a single shot ultrasound guided subsartorial saphenous nerve block above the knee were performed with the patient awake. Surgery was performed under spinal or general anaesthesia.
An ambulatory elastomeric pump delivering 0.2% levobupivacaine at 5mls/hr was connected at the end of the operation.
We collected data prospectively on the first 31 patients having this procedure. Primary outcome measures were length of stay (LOS), opiate consumption and patient satisfaction.
Retrospective LOS data was also collected for previous 31 patients who underwent surgery before this technique was introduced.
Results
Control (pre-catheter)
•Mean LOS 2.4 nights (0 day-of-surgery discharge) (95% CI = 1.9-3.2)
Catheter
•Mean LOS 1.5 nights (4 day-of-surgery discharge) (95% CI = 1.0-2.2)
p = 0.023
•Average Oramorph™ first 24 hours 18.7 mgs
•Average Oramorph™ next 24 hours 9 mgs
•96% satisfied with pain relief first 24hrs
•92% would have same anaesthetic again
Conclusion
Day of surgery discharge can be achieved using this technique. High quality patient information must be available both pre and post-operatively. Patient follow-up and a system for re-admission in the case of block failure must also be in place.
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