A PROSPECTIVE AUDIT OF PERIOPERATIVE ANALGESIA AS PART OF ENHANCED RECOVERY PROGRAMME FOR DAY CASE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
12 slide(s) – English – 2011-09-08
Background and Aims
Anterior cruciate ligament (ACL) reconstruction is common amongst young, healthy patients. Day case surgery reduces disruption to patients, healthcare costs and promotes early mobilisation.
This prospective audit evaluates peri-operative analgesia facilitating same day discharge after ACL reconstructions as part of enhanced recovery programme. Our strategy aims to achieve adequate pain control with local infiltration analgesia (LIA) and multimodal systemic analgesia, preferably avoiding femoral nerve block, which can delay patients’ discharge.
20 consecutive patients underwent ACL reconstruction (autologous hamstring graft) under general anaesthesia were followed up for 24 hours. LIA was administered to the donor site immediately after harvesting and to soft tissues of the knee before closure. One ASA 3 patient received an additional femoral nerve block (FNB) with 20 ml of 1% prilocaine, anticipating higher analgesia requirements. Post-operatively, all patients were prescribed oral paracetamol and codeine, with rescue tramadol available. Criteria for discharge were satisfactory vital signs, absence of nausea, pain score <3 (Numeric Rating Scale 0-10), mobilisation with sticks.
Mean pain score was 2.55, 7-9 hours post-operatively. 1/20 required rescue tramadol. 20/20 met discharge criteria on day of surgery. Patient satisfaction was rated as “Excellent” and “Very Good” by 15 and 5 patients respectively. All mobilised well and required no additional analgesia at home upon telephone follow-up within 24 hours .
LIA, as part of multimodal analgesia, provided good pain control, high patient satisfaction and rapid discharge post-operatively. This protocol is successful within our institution’s enhanced recovery programme for ACL reconstructions.