Background and Aims The ideal regional anaesthetic technique for unicompartmental knee replacement (UKR) should provide good analgesia without compromising patient ability to mobilise post-operatively. Various approaches to blockade site and volume have been considered1. Low volume ACB should avoid motor blockade of medial vastus nerve and inadvertent proximal local anaesthetic spread and quadriceps weakness. In our tertiary orthopaedic centre a standard operating procedure (SOP) was created advising low volume, low concentration adductor canal blockade (ACB) of the saphenous nerve with 10ml 0.2% ropivacaine, alongside effective surgical local infiltration.
Methods This ethics-approved prospective audit reviewed records of around 30 consecutive patients undergoing UKR, and assessed whether ACB was performed, dose and volume of local anaesthetic used, and 24-hour post-operative opiate consumption. Two cycles were performed; one pre-SOP introduction, one six months post-introduction. For comparison, data were grouped as ‘compliant with recipe,’ ‘non-compliant’ or ‘no ACB performed.’
Results Pre-SOP, a total of 17 different ACB recipes were utilised, with large variations in post-operative opiate consumption. Re-audit showed utilisation of ACB in 70% of cases, and 57% compliance with SOP when ACB was performed. Post-operative opiate consumption decreased when ACB was compliant versus non-compliance, from 40.4mg to 22.5mg oral morphine equivalence. When ACB was not used, opiate consumption was markedly higher at 76mg.
Conclusions Appropriately sited low volume, low concentration ACB can improve patient experience post-UKR. Introduction of a local SOP in such patients has shown good clinician uptake in addition to reduced post-operative analgesia use. Further targeted clinician education will now aim to improve performance and patient outcomes.
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