Abstracts and Programme, EUROANAESTHESIA 2008: Ambulatory Anaesthesia
Background and Goal of Study: Vastus medialis obliquus (VMO) muscle is the major dynamic stabilizer of the patella. Arthroscopic repair of VMO with lateral release is done for anterior patellar stabilization which is common in sports injuries. This surgery is associated with moderate to severe pain, many times requiring in-patient admission due to inadequate pain control. With advancement of analgesic technique and home infusions it's now being done as day case. We did a prospective audit to find out the analgesic technique and post op admission rate for arthroscopic VMO advancement as ambulatory surgery.
Materials and Methods: This prospective audit was done for a period of 6 months after institute approval. All the patients fulfilled our day surgery fitness criteria. All of them had general anaesthesia.Multimodal analgesic technique included,Oxycontin 10mg as pre-emptive analgesia with either ultrasound guided single shot femoral nerve block (SFNB) or continuous femoral nerve block (CFNB). Intra-op patients received IV paracetamol, dexamethasone and parecoxib. 20 mls of 0.5% bupivacaine was given as SFNB. For CFNB, stimulating catheter was used and 2% lignocaine with epinephrine 10-20 mls given as bolus. For maintenance 0.1% ropivacaine, 5 mls/hour as a continuous infusion delivered by elastomeric pump. Rescue opioids given as appropriate. Oral Diclofenac and Codeine were given to take home. Patients were educated regarding continuous catheter. They were asked to remove the catheter after 72 hours by themselves. If not they came to the hospital. If any problems they were asked to contact the attending anaesthetists. Telephonic follow up were done at 24 and 48 hrs.Details of pain score, sleep and any problems were noted. Post op admissions were defined as AR, if not discharged within 24 hours and RAR, if admitted after 24-48 hrs. Discharge criteria were followed according to institute protocol.
Results and Discussion: 25 patients were followed during this period. Readmission rate in SFNB was 40% compared to none in CFNB and home infusion patients.
Conclusion(s): No admission were required in patients who had multi modal analgesic technique with continuous femoral nerve block and home infusion for arthroscopic VMO advancement. Optimal technique, equipment, follow up and patient oversight to be determined by prospective, controlled trials.