title: Open repair of the acutely torn Achilles tendon under local  anaesthetic.
abstract: BACKGROUND
  Where surgery has been preferred, the torn Achilles tendon (AT) has most commonly been repaired under general or spinal anaesthetic (GA). Repair using local anaesthetic (LA) has been reported, but does not appear to be widely used.
  
  
  METHODS
  We retrospectively reviewed 87 patients, following open repair using either GA or LA at Nelson Hospital, 2001–2005. Calf strength and ankle range of motion (ROM) were assessed. Subjective pain and function were assessed using the American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire. Complications, time off work and sport, time in theatre, and hospital were recorded.
  
  
  RESULTS
  Fifty-nine tendons were repaired under GA (68%) and 28 under LA (32%). Outcomes were similar for each group. There was no significant difference in strength and ROM. Foot and Ankle Questionnaire scores were similar. Total theatre time averaged 57 min for GA and 37 min for LA (P = 0.01). LA repairs (82%) were performed as a day case compared with 10% of the GA repairs (P = 0.01). LA patients had a quicker return to work. GA complications included two deep vein thromboses and two pulmonary emboli. One patient from each group had a re-rupture.
  
  
  CONCLUSIONS
  A repair of the acutely ruptured AT under LA is at least as effective as repair under GA with regard to function, long-term pain and patient satisfaction. LA repair results in significant cost savings due to less theatre time, fewer anaesthetic costs, and a shorter hospital stay.
authors.affiliation: Nelson-Marlborough District Health Board, Nelson, New Zealand. adimacquet@gmail.com
authors.forename: Adrian Jules
authors.initials: AJ
authors.lastname: Macquet
authors.forename: Rosie Jane
authors.initials: RJ
authors.lastname: Christensen
authors.forename: Matthew
authors.initials: M
authors.lastname: Debenham
authors.forename: Michael
authors.initials: M
authors.lastname: Wyatt
authors.forename: Allan Leslie
authors.initials: AL
authors.lastname: Panting
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D012421:Rupture; D016896:Treatment Outcome