B100 “Dream” tubeless opiate free anaesthesia achieved with peripheral nerve blocks for knee replacement surgery – an observational study
Affiliation
George Eliot Hospital, NuneatonPublication date
2022-08-11Subject
Anaesthesia
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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 )Citation
Gulia V, Dasgupta K, Sarkar S, Mallick I. B100 “Dream” tubeless opiate free anaesthesia achieved with peripheral nerve blocks for knee replacement surgery–an observational study. Regional Anesthesia & Pain Medicine 2022;47:A134. doi: 10.1136/rapm-2022-ESRA.175.Type
Conference OutputPublisher
BMJ Publishing Groupae974a485f413a2113503eed53cd6c53
10.1136/rapm-2022-ESRA.175