Optimising Anaesthetic Factors to Facilitate Day Case Anterior Cruciate Ligament Repair

Abstract

Introduction: The service level report generated by GIRFT (Get It Right First Time) showed that the average length of stay (LoS) for Nottingham University Hospitals (NUH) Trust following Anterior Cruciate Ligament Repair (ACLR) from April 2017 to March 2018 was 1.35-days. Reducing our LoS to match the national average of 0.13-days could save an estimated £45,000. We performed a review of anaesthesia and specifically postoperative nausea and vomiting (PONV) and pain as factors which may be contributing to our increased LoS to enable us to formulate perioperative guidelines.

Methods: 113 patients underwent ACLR in NUH between March 2018 and March 2019. Pain and PONV scores were analysed from recovery and at six-hourly intervals postoperatively using electronic observation data along with analgesic and antiemetic regimes used intra and postoperatively.

Results: Forty-seven patients (42%) experienced moderate-severe pain in the recovery room and 12 and 11 patients (11%, 10%) at 6 and 12-hours, respectively [Fig. 1-3]. Four patients (3.5%) received intraoperative local anaesthetic infiltration, and 13 patients (12%) received a femoral or adductor canal nerve block.

Conclusion: Use of intraoperative local anaesthetic infiltration/nerve block has been shown to improve pain control for up to 24-hours in ACLR [4]. We recommend use of local anaesthetic infiltration or regional anaesthetic nerve block for all patients as well as use of multi-modal postoperative analgesia consisting of paracetamol, NSAID’s and an opioid as part of the discharge medication for the first 48-hours to provide optimal analgesia and facilitate day case surgery. We are in the process of formulating day surgery pathways and guidelines to reduce inpatient stay, improve patient experience and save revenue for the Trust.