Continuous post-operative regional analgesia at home.
OBJECTIVE
Describe early discharge of patients treated with continuous perineural analgesia after orthopaedic surgery.


METHODS
A prospective and descriptive study including 56 patients undergoing multiple orthopaedic procedures, who had received oral and written information and given informed consent. Literature on the topic was reviewed, a preliminary study performanced and home nurses were trained. The following blocks were performed: interscalene block (ISKT), infraclavicular block (ICKT), posterior popliteal sciatic block (PPKT) or tibial block at the ankle (TKT). The analgesic catheter (KT) was inserted pre-operatively with nerve stimulation technique. Blockade was induced with mepivacaine and surgery performed under regional anaesthesia. Postoperatively, an elastomeric pump delivering 0.2% ropivacaine(R) at 5 ml/h (tibial blocks) and 7 ml/h (other blocks) was implemented. Analgesic efficacy and side-effects were monitored for 24 hours (patient discharge on Day+1). Pain was evaluated using visual analogical scores (VAS) (0-100) every 12 hours; rescue analgesics were prescribed (propacetamol IV). Nurses ensured patient monitoring at home. Finally, each patient was asked a satisfaction score (0-100).


RESULTS
Two patients were excluded. Twenty-one tibial blocks, 24 posterior popliteal sciatic blocks, 6 infraclavicular blocks and 3 interscalene blocks were performed. No major incidents were reported. VAS showed satisfactory post-operative analgesia. Median values (max-min) were measured every morning and evening on Day+1 and Day+2. Patient satisfaction was high: 89 (70-100). Hospitalisation costs analysis showed a 46 to 27% decrease in surgery-depending costs.


CONCLUSIONS
Continuous, post-operative, perineural analgesia at home is safe and effective, less expensive with high patient satisfaction.
Macaire
P
P
Orthopaedic Clinic, Lyon, Italy.
Gaertner
E
E
Capdevila
X
X
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D004867:Equipment Design; D005260:Female; D006701:Home Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods*; D019637:Orthopedic Procedures; D010351:Patient Discharge; D011446:Prospective Studies; D013997:Time Factors