Background and aims Revision total knee replacement surgery (RTKR) is challenging to patients due to severe postoperative pain and high risk of deep vein thrombosis (DVT) due to prolonged immobility. Retrospective data collection audit conducted to assess the quality of analgesia, time for active physiotherapy and length of stay (LoS) using U/S guided adductor canal continuous nerve block.
Methods Retrospective audit of 17 patients over 3 months. Pajunk e-catheter used towards the end of the procedure with the patient in supine position. All patients received standard spinal anaesthetic (0.5% bupivacaine heavy +300mcg diamorphine) and general anaesthetic. Patients were given 15 mls of 0.125% chirocaine plain after catheter insertion in the mid-thigh canal (Out of plane approach using 12Hz probe), then connected to an elastometric (Braun) pump @5 mls/hr. Patients modified early warning scores (MEWS) are reviewed from written and electronic notes on Lorenzo software, alongside time to weight bear, physiotherapy, amount of rescue analgesia and LoS.
Results Data suggested that average time to weight bear is 1.7 days with active physiotherapy participation from day 1.9 days, rescue analgesia of oxynorm 3.8 mgs and LoS of 4.5 days. One patient’s catheter fell off on day 2, needing a re-insertion on the ward. None had any complications.
Conclusions Adductor canal catheters can be considered as part of multimodal analgesia following RTKR. This reduces time for active physiotherapy and LoS saving hospital expenditure and bed occupancy. This audit mandates a multi-centre trial to assess the risk of complications and make a recommendation regarding the effectiveness of this approach.
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