Abstract
Anterior cruciate ligament reconstruction has been traditionally performed as an inpatient due to post-operative analgesic requirements.
Increased patient demands and pressures of bed shortages have led to the development of day case surgery.
Day case anterior cruciate ligament (ACL) reconstruction surgery using an analgesic pump was assessed.
24 consecutive ACL reconstructions using arthroscopic hamstring technique were performed as day case procedures.
All received a standard anaesthetic of propofol, fentanyl, tenoxicam, and morphine. And an intra-articular administration of 10mls 0. 75% Ropivicaine Hydrochloride at the end of surgery.
0. 2% Ropivicaine at a rate of 2mls/hr was infused over 48hrs using a compression spring infusion pump (Pain Control Infusion Pump – Sgarlato Labs) via an intraarticular catheter.
Post operative pain was assessed by a Visual Analogue Score (VAS) recorded by the patient onto an unmarked 1 Ocin line (0 – no pain ; 1 0 – maximum pain)
For the 48hrs the pump was infusing the average VAS was 2. 7 with minimal additional analgesia required.
Following pump removal by a District Nurse, the average VAS score was 1. 9 with similar analgesia requirements
All patients were satisfied with their care; none had problems related to the use of or removal of the pump; none required re-admission or review from their GP; or suffered post-operative complications.
The cost for day case surgery was 260 (including theatre time; pump and drug costs; District Nurse costs) compared to 1072 for an average in-patient stay of 4 days (both exclude ACL specific implants, surgeon and anaesthetist costs).
The intra-articular infusion of local anaesthetic has been shown to be well received by patients with no additional risks.
It is an effective and cost-effective means of providing post-operative analgesia allowing day case ACL Reconstruction surgery to be performed.
This study has demonstrated that there are no requirements for additional resources from primary care.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom
