Nigel M. Bedforth

Background and Aims Anaesthesia and post-operative analgesia for patients undergoing total knee arthroplasty (TKA) has evolved over the last 20 years. Our aim was to carry out a quality improvement project to assess the benefit of motor sparing nerve blocks which includes the IPACK and low femoral triangle blocks¹. We aimed to assess post-operative pain scores and analgesic requirements². Methods We carried out a retrospective analysis of patients undergoing TKA including 46 patients after seeking approval from the local audit committee. We used medical notes to obtain patient characteristics, method of anaesthesia and analgesia provision, opiate consumption, and pain scores. Results 100% of patients had a spinal anaesthetic with 1 patient requiring conversion to GA. 41% of patients had a combined IPACK and low femoral triangle block. The remainder received LAI by the surgeon. The mean request for first opiate dose was earlier by 20 min in the block group. Opiate consumption was significantly lower in the first 24 hours by 21 mg OME. 90% had no to mild pain at 24 hours in the block group compared to 63% in the LIA group. Pain scores at 48 hours were similar in both groups. A multimodal approach to analgesia was used for all patients. Conclusions Motor sparing nerve blocks for patients undergoing TKA is beneficial in the first 24 hours with improved pain scores, reduced opiate consumption as well as surgeon satisfaction. We have implemented recommendations to add these to our ERAS pathway and aim to train anaesthetists in performing these blocks for all TKA patients.

The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation. The trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled. This is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting. International Standard Randomised Controlled Trial Number Registry, ISRCTN29129799 . Prospectively registered on 12 June 2018.

(Abstracted from Anesthesiology, 123:1188–1197, 2015) Ultrasound-guided regional anesthesia (USGRA) requires manual dexterity and hand-eye coordination and is related to an individual's ability to mentally rotate and manipulate 2- and 3-dimensional objects (visuospatial testing). The primary goal of this study was to determine whether visuospatial ability could predict technical performance of an ultrasound-guided needle task by novice operators.

Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem.