B100 "Dream" tubeless opiate free anaesthesia achieved with peripheral nerve blocks for knee replacement surgery – an observational study. (11th August 2022)

• Record Type: Journal Article
• Authors: Gulia, V; Dasgupta, K; Sarkar, S; Mallick, I
• Is Part Of: Regional anesthesia and pain medicine. Volume 47(2022)Supplement 1
• Page Start: A134
• Page End: A134
• Publication Date: 2022-08-11
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2022-ESRA.175
• Languages: English
• ISSNs: 1098-7339

Abstract

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 )