054 Evaluation of the regional anaesthesia service provided for upper-limb plastic surgery

Published Date: 11th January 2022

Publication Authors: Murtagh L, Mukhtar K

Background
This study evaluates the impact of preoperative education on the length of hospital stay after foot and ankle surgery. There are several studies on the benefits of preoperative education prior to hip and knee arthroplasty, especially their role in facilitating early discharges. But studies on the benefits of foot school (Preoperative education) prior to Foot and Ankle surgeries are limited. The aim of this study was to determine if Foot school played a role in expediting early and safe discharges in patients of elective foot and ankle surgeries METHODS: All patients listed for an elective foot and ankle procedure were invited to attend foot school, which consisted of a multi-disciplinary team whose aim was to educate patients about their surgical procedures, rehabilitation and discharge goals. Not all patients attended foot school, as attendance to foot school was recommended but not mandatory for surgery. Data on all foot and ankle surgeries performed in 2019 were collected, and patients were divided into two groups based on their foot school attendance.

Methods
The objective of this quality-improvement project was to conduct an evaluation of the regional anaesthesia service as well as to compare it with the similar plastics surgery lists carried out under general anaesthesia. The parameters that were assessed included anaesthetic time, length of postoperative stay, need for conversion to general anaesthesia and patient satisfaction. There were two groups of patients. The first group had upper-limb surgery carried out solely under regional anaesthesia. An ultrasound-guided supraclavicular brachial plexus block ± peripheral nerve blocks. All blocks were performed by a consultant anaesthetist. One per cent or 2% lidocaine with 1:200,000 adrenaline was used for all blocks. The second group had upper-limb surgery carried out under the general anaesthesia. Data were collected, including the type of surgery and blocks used, anaesthetic time, recovery time and length of hospital stay post-surgery. Patients in the regional group were contacted postoperatively with a questionnaire to assess their service satisfaction. The data were obtained mainly by using the electronic theatre and healthcare records and information provided by the consultant performing the blocks. There was no conversion to general anaesthetic in the regional group. In general, patients’ experience was positive.

Results

*Patients were immediately ready to be discharged home after the surgical procedures. Delays in discharge were due to logistics, for example transport, etc.

Discussion
Having a procedure done under regional anaesthesia helps to avoid the risks related to general anaesthesia. Currently, during the COVID-19 pandemic, it is particularly important as it avoids airway manipulation and healthcare workers' exposure to aerosol-generating procedures. Our evaluation shows that the ultrasound-guided brachial plexus block for upper-limb plastic surgery as a primary mode of anaesthesia is reliable, significantly reduces hospital stay post-procedure and eliminates the need to stay in recovery.

Spodniewska, E; Murtagh, L; Mukhtar, K. (2022). 054 Evaluation of the regional anaesthesia service provided for upper-limb plastic surgery. Anaesthesia. 77 (S2), 34

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