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#36336 Introducing an ambulatory spinal service for orthopaedic surgery at a district general hospital
  1. Natalie Shields
  1. Anaesthetics Department, Princess Royal University Hospital, King’s College Hospital NHS Trust, Orpington, UK


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Short-acting intrathecal local anaesthetics, such as prilocaine, have advantages for ambulatory day-case surgery due to rapid onset and offset of anaesthesia, rapid recovery of protective reflexes, mobility and micturition. Intrathecal prilocaine for day-case unicompartmental knee replacement (UKR) has been introduced at an orthopaedic hospital in the UK. The study aims are: 1. To assess feasibility of an ambulatory spinal service for elective UKR 2. To introduce prilocaine for day-case UKR

Methods Stage 1 was a retrospective review of 29 UKRs in 2020 recording time from anaesthesia to surgery end to demonstrate feasibility of prilocaine use. Stage 2 recommended using heavy prilocaine 20% with fentanyl. Data collected for UKR cases between Jan – May 2023 included anaesthetic dose, time from anaesthesia to surgery end, post-operative pain scores, analgesic requirements, length of stay and patient satisfaction.

Results Stage 1 found that mean procedure time was 72mins. Stage 2 found that 80% were discharged within 24h, 0% had urinary retention, pain scores were between 2-10/10, they all required oral opiate analgesia, time to mobilisation was poorly documented, patient satisfaction was between 4 and 5 out of 5.

Conclusions UKR can successfully be achieved as a day-case procedure with intrathecal prilocaine. To facilitate this patients should be first on the theatre list and receive pre-operative education regarding physiotherapy and post-operative analgesic requirements. Good analgesia is required with regular paracetamol, NSAIDs if not contraindicated and opiates. A guideline for all multidisciplinary teams, including physiotherapy, pharmacy and the ward nurses will further support same day discharge.

Attachment Ethics approval not required.pdf

  • Day case
  • prilocaine
  • ambulatory

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