Daycase Anterior Cruciate Ligament Reconstruction: Success, Pitfalls and Patient Pain Scores

摘要

Daycase Anterior Cruciate Ligament (ACL) reconstructions with hamstring autograft have been undertaken in this trust for the last 6 months. Performing the procedure as a daycase potentially reduces the risk of infection and cancellation as well as reaching government targets for the performance of at least 75% of all surgical procedures as a daycase. We analysed our attempted daycase ACL reconstructions between April 2009 and October 2009. We assessed success of the daycase discharge as well as reasons for failed discharge. Patients’ pain scores were assessed for the week post-surgery and patient satisfaction with the daycase procedure was also documented.Daycase ACL reconstructions were attempted in 50 patients. Average age was 31.0 years and there were 36 males and 14 females in the cohort. 29 patients were discharged as a daycase and 21 patients required inpatient stay (38% social reasons, 33% late back to ward, 10% due to pain, 10% dues to dizziness and 10% due to failed physiotherapist assessment)Patients having daycase ACL reconstructions have significantly less pain from days 1-3 post-operatively (p=0.05) compared to inpatients. There is no significant difference (p=0.05) between different nerve blocks used (Femoral vs Femoral and Sciatic). No correlation was noted between increased pain and additional procedures performed at the time of the ACL reconstruction.100% of patients claiming they were happy with the daycase procedure and 96.6% would agree to have the procedure performed as a daycase again. New protocol has been devised to allow daycase ACL reconstructions to be performed only in the mornings. Anaesthetic has been standardised with General anaesthetic and only femoral nerve block. Re-audit has shown that the majority of patients are now discharged as a daycase and patient outcome is improved.We conclude that daycase ACL reconstruction does not cause significantly increased pain and grants excellent patient satisfaction. There is no apparent difference in pain scores between patients having femoral nerve blocks and those having sciatic blocks added in. The procedure is safe and efficient and will continue to be offered in the trust