PROSPECTIVE ANALYSIS OF POSTOPERATIVE PATIENT COMFORT AFTER CONVENTIONAL BANKART PROCEDURE PERFORMED IN AN OUTPATIENT SETTING

Abstract

Purpose: The Bankart procedure is widely studied in the literature. The general lack of postoperative complications is well recognised. The purpose of this work was to study patient comfort after Bankart procedures performed in the outpatient setting in order to validate the feasibility of this approach.

Material and methods: Thirty patients underwent Bankart procedure from June 2001 to 2002 performed by the same surgeon in an outpatient clinic. There were 28 men and two women, mean age 28 years. Pain was assessed with a visual analogue scale (VAS) at entry into the recovery room (P0), when leaving the recovery room (P1), on day 1 by telephone (P2), and on day 7 at consultation (P3). On day 1 and day 7, the patient was also asked if he/she preferred staying in hospital one night. The general anaesthesia protocol was the same for all patients. Intraopeartive analgesia was 20 mg nefopam (Acupan(r)) in a half-hour infusion, 2g propacetamol (Prodafalgan(r)) or paracetamol (Perfalgan(r)), and 100 mg ketoprofen (Profenid(r)) if there were no contraindications. In the recovery room, 3 mg morphine was delivered in by iv bolus until the VAS was less than 4/10 followed by oral paracetamol-codeine combination. Home treatment used 200 mg/d ketoprofen and paracetamol+codeine.

Results: The only complication was one superficial venous thrombosis of the upper limb diagnosed on day 15. There were no cases of postoperative haematoma or infection. One patient stayed one night in hospital after the procedure due to a vagal malaise which occurred at discharge; the VAS pain score was the same in this patient as in the others. Pain assessment was: D1=2 (5. 0); D2=1 (3, 0). Postoperative comfort was thus considered satisfactory. None of the patients would have preferred 24h hospitalisation.

Discussion: There has been only one series of 25 patients reporting results of patient comfort and cost of outpatient Bankart procedure. Patients underwent surgery with a scalene interblock. Three of the 25 patients preferred a 24h hospitalisation because of pain, perhaps due to the rebound pain effect after the block. Absence of drainage did not lead to any case of haematoma, confirming an earlier unpublished study of 50 consecutive patients who underwent classical hospital procedure without drainage. Only one patient had a subcutaneous haematoma that resolve favourably spontaneously. These results suggest that satisfactory patient comfort can be achieved postoperatively for outpatient procedures. We have decided to pursue this approach.