Abstract
Purpose
To prospectively assess the safety, efficacy and patient satisfaction of a standardised perioperative anesthetic and pain management protocol for outpatient Total Ankle Arthroplasty.
Method
Starting February 2008 we chose to enrol 50 consecutive patients undergoing Total Ankle Arthroplasty in this study. All patients were assesed and treated by a single Anesthesiologist and Orthopedic surgeon. All patients received preoperative dosing of Celebrex, Oxycontin and Gabapentin. Anesthesia consisted of a popliteal regional block and a spinal anesthetic. Patients were discharged home when they were stable with adequate pain control and able to ambulate with crutches or a walker. All patients were contacted by telephone by the treating Anesthesiologist to assess for pain control, complications and satisfaction on the night of surgery and for the next two days. Patients were also given contact numbers to call the Anesthesiologist for any concerns outside of these times. All patients were assessed by the treating Orthopedic surgeon at two and six weeks post surgery with data collected regarding wound complications, infection, deep venous thrombosis and overall patient satisfaction.
Results
All 50 consecutive patients underwent successful regional and spinal anesthesia. All patients were stable for discharge the same day as the surgery. One patient experienced nausea in the Recovery Room but was treated with standard antinausea medication and was subsequently discharged home. Forty three patients reported pain scores of less than 3/10 throughout the post operative phase. Four patients experienced mild pain (3/10) and three patients reported moderate pain level (5/10). All seven patients were treated with analgesic dose titration and/or education regarding the need to take all medications prescribed at the proper time intervals. None of the patients required further intervention or readmission for either pain control or complications of anesthesia.
All patients were reviewed by the treating Orthopedic surgeon at two and six weeks postoperatively. There were no early surgical complications and all wounds healed without difficulty or sepsis. All patients admitted to being satisfied or highly satisfied with their surgical experience and post operative pain management.
Conclusion
Total Ankle Arthroplasty can be performed safely on an outpatient basis with excellent pain control and a high level of patient satisfaction. We now utilize regional anesthesia and the multimodal pre- and post-operative pain management protocol described for all complex foot and ankle surgery. This has allowed for greater throughput of operative cases and significant cost savings for our Institution.
