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Abstract
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 )