Postoperative Patient-Controlled Local Anesthetic Administration at Home

Purpose: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case illustrates the use of lumbar plexus and sciatic nerve peripheral catheters for major knee surgery using intermittent bolus dosing for outpatient analgesia.Clinical features: A 20-yr-old male presented for multi-ligamentous knee reconstruction (posterior collateral ligament and revision anterior collateral ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general anesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0.2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 ml in each catheter (four injections total). This provided 96 hr of analgesia and low supplemental opioid use. Conclusion:The use of a lumbar plexus and sciatic nerve peripheral catheter offered an alternative to conventional pain control that worked well in the ambulatory setting. By providing prolonged unilateral lower limb analgesia, extensive knee surgery was performed that would normally require a hospital stay for pain control. Using a bolus dosing method the risk of local anesthetic complications occurring outside of the hospital with a continuous infusion was minimized. AJOR reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Surgery such as total knee arthroplasty or multi-ligament reconstruction (as opposed to single anterior cruciate ligament repair) often involves a large incision, substantial soft tissue dissection and multiple osteotomies. As a result patients frequently require large doses of post-operative iv narcotics or continuous epidural analgesia. The care required to manage these modalities usually makes early hospital discharge difficult and prohibits performing this surgery on an ambulatory basis.Continuous peripheral nerve blockade (CPNB) is an alternative technique that can provide prolonged REGIONAL ANESTHESIA A N D P A I N

“…6,7 Major surgery of the knee joint requires anesthesia of both the lumbar plexus and the sciatic nerve. The knee joint is innervated primarily by the femoral nerve.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade

Klein

Greengrass

Grant

et al. 2001

“…2 Recently, several groups have published data on the efficacy of continuous ambulatory infusion of local anesthetics at home. [3][4][5] In these reports, profound analgesia was obtained resulting in an opioid sparing effect for upper and lower extremity surgery. Despite these encouraging results little information regarding outcome was provided to support using these novel interventions in an ambulatory setting.…”

Section: éLéments Cliniques : Quatre Patients Opérés Pour La Réparatimentioning

confidence: 99%

Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases

Nielsen

Greengrass

Pietrobon

et al. 2003

P Pu ur rp po os se e: : Continuous interscalene brachial plexus blockade (CIBPB) in a hospital setting can provide excellent surgical conditions and postoperative analgesia for major shoulder surgery. This is a case report of four patients on the efficacy and advantages of CIBPB for postoperative analgesia at home.C Ca as se e r re ep po or rt ts s: : Four patients scheduled for rotator cuff repair under CIBPB were discharged home the day of surgery with an interscalene catheter connected to an automated infusion pump administering 0.2% ropivacaine at 10 mL·hr -1 for 72 hr. Prior to discharge, patients and their attendant were given verbal and written instructions concerning local anesthetic toxicity and explicit contact information for an anesthesiologist or nurse. Outcomes were measured pre-and postoperatively, including verbal analogue pain scores (pain VAS), verbal analogue nausea scores (nausea VAS), side effects, cognitive function (mini-mental state questionnaire), sleep (hours/night), and patient satisfaction (Likert scale). Postoperative VAS scores over three days were very low. Two patients reported only one episode of nausea. There were no complications associated with local anesthetic toxicity or catheter use. Cognitive function improved over three days. Sleep increased from a mean of five hours before surgery to seven hours over the next three nights. Patient satisfaction with care was high. Significant cost savings were documented.C Co on nc cl lu us si io on n: : The use of CIBPB for 72 hr in patients undergoing major ambulatory shoulder surgery can result in good analgesia with minimal opioid requirement, cost savings and possibly improvement in outcome measures.

“…This method enables repeated applications of the LA postoperatively by nurses, on the surgical ward, or even by patients at home. 3,7 The catheter can be connected to an elastomeric balloon-pump which delivers a given volume of LA solution determined by opening the clamp for a specific period of time.…”

Section: Méthodementioning

confidence: 99%

“…R Re es su ul lt ts s: : During the first 24 hr, median number of LA applications in 26 B patients was 4 (range [1][2][3][4][5][6] and in 25 R patients 3 (range [1][2][3][4][5]. Both groups showed low VAS pain scores: less than 2 at rest, less than 4 with movement.…”

mentioning

confidence: 99%

“…C Co on nc cl lu us si io on n: : Self-administration of the LA solution via a catheter in the surgical wound is an effective method of pain relief after IHR with little side-effects. [1][2][3][4] Postoperative pain is often treated with less potent opiods, non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol given by the oral or im route, but these methods are not always effective. Intravenous analgesia is predictable and effective but demands well defined safety measures and cannot be administered at home after day surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

L’auto-administration de bupivacaïne ou de ropivacaïne au site d’incision procure une analgésie efficace a la suite d’une herniorraphie inguinale

Vintar

Pozlep

Rawal

et al. 2002

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