• P Macaire, E Gaertner, and X Capdevila.
• Orthopaedic Clinic, Lyon, Italy.
• Minerva Anestesiol. 2001 Sep 1;67(9 Suppl 1):109-16.

ObjectiveDescribe early discharge of patients treated with continuous perineural analgesia after orthopaedic surgery.MethodsA 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).ResultsTwo 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.ConclusionsContinuous, post-operative, perineural analgesia at home is safe and effective, less expensive with high patient satisfaction.

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