Circular External Fixator Removal in the Outpatient Clinic Using Regional Anaesthesia: A Pilot Study of a Novel Approach

Abstract

A bstract Introduction External fixator (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under general anaesthesia in an operating theatre. This practice is resource-intensive and limits the amount of time available for other surgical cases in the operating theatre. We aimed to assess the use of regional anaesthesia as an alternative method of analgesia to facilitate the EF removal in an outpatient setting. Design and methods This prospective case series evaluated the first 50 consecutive cases of EF removal in the outpatient clinic between 10/06/22 and 03/02/23. Regional anaesthesia using ultrasound-guided blockade of peripheral nerves was administered using 1% lidocaine due to its rapid onset and short half-life. Patients were assessed for additional analgesia requirements and then were asked to evaluate their experience and perceived pain using the visual analogue scale (VAS). Results Fifty patients were included in the study. The mean age was 46.8 years (range 21–85 years). About 54% of the patients were male patients ( N = 27). Post-procedure, all patients indicated positive satisfaction ratings, each participant responded as either ‘satisfied’ ( N = 6), ‘very satisfied’ ( N = 24) or ‘highly satisfied’ ( N = 20). In addition, 90% of the participants reported that they would opt for this method of EF removal again in future. The VAS for pain immediately following completion of the procedure was low, with a mean score of 0.36 (range 0–4), where a score of 0 = ‘No pain’, and 10 = ‘worst pain possible’. The median score was 0. Conclusion We present the first description of outpatient EF removal using regional anaesthesia, with a prospective case series of 50 fully conscious patients from whom the EF was removed. This novel technique is likely to be cost-effective, reproducible, and safe. This technique reduces the burden of EF removal from an operating list and also improves the patient's experience when compared with other forms of conscious sedation. By eliminating the use of Entonox and methoxyflurane for sedation and analgesia, this technique also demonstrates a method of improving environmental sustainability. How to cite this article Williams LM, Stamps G, Peak H, et al . Circular External Fixator Removal in the Outpatient Clinic Using Regional Anaesthesia: A Pilot Study of A Novel Approach. Strategies Trauma Limb Reconstr 2023;18(1):7–11.

Penthrox® (Methoxyflurane) as an Analgesic for Removal of Circular External Fixators and Minor Procedures during the COVID-19 Pandemic

“…Usually, these procedures are performed under a general anaesthetic in the operating theatre but there is also an increasing trend for alternative modalities in the clinic, including the use of nitrous oxide (Entonox®) as well as regional nerve blocks. 1 The cost of a three-session theatre list is more than £3000 in our trust and removal of external fixation represents a significant use of theatre time. This has become an ever more valuable commodity especially in the post-pandemic era as the National Health Service (NHS) deals with waiting lists following the COVID-19 pandemic.…”