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B100 “Dream” tubeless opiate free anaesthesia achieved with peripheral nerve blocks for knee replacement surgery – an observational study
  1. V Gulia,
  2. K Dasgupta,
  3. S Sarkar and
  4. I Mallick
  1. George Eliot Hospital, Nuneaton, UK


Background and Aims Perioperative opioids mainstay analgesia for Knee replacement surgery.Spinal opioids cause urinary retention, itchiness and vomiting.Cumulative opioid consumption causes increase CRP and fibrinogen levels- acute phase reactants.

High opiate use cause physical dependence hence we planned Tubeless opiate free anaesthesia to fulfill our DREAM((Drink, Eat, Analgesia, Mobilise) .

Methods Prospective Study done in 24 Patients undergoing elective Knee replacement surgery . Low dose spinal Bupivacaine heavy 0.5% 2.4 mls.No intrathecal opiates and Urinary Catheters not inserted. Adductor cana l (Figure 1) at apex of femoral triangle(FT)- 15 mls Ropivacaine 0.375%. Genicular blocks - SM,SL,IL-15 mls, IPACK (Figure 2&3) - above condylar level- 12 mls( max total dose Ropivacaine 3mg/kg ).

Intraoperative analgesia was Paracetamol, Parecoxib and Mgso4.

Tourniquet used for all.

Results In patients with Nerve blocks patients length of stay was reduced by 2 days.Median Motor recovery time 3 hours.

No Urinary catheter was required in opiate free group.

Opiates requirement was reduced in post operative period

Tubeless “DREAM “ was achieved postoperatively (No IV , Oxygen tubes & urinary catheters required).

Only patients with high Preoperative pain scores asked for further pain relief 24 hrs postoperatively & 16 patients didn’t require opiates.

Conclusions Opiate free Anaesthesia gives better results for enhanced recovery in post operative knee replacement patients.

Ultrasound guided Adductor canal/IPACK blocks indicated to spare intrathecal opiate and postoperative opiate requirements.

DREAM for Knee replacement patients can be realised . Our mission was to wean patients from preoperative opioids. Our technique of RA is the mainstay in achieving that.( Ethical committee approval granted audit number 841_341 Georgeeliothospital )

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