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