Rosalind Rashid
Introduction
Post-operative mobilisation and discharge can be expedited using short-acting local anaesthetics (e.g. prilocaine) for day-case lower limb arthroplasties performed under spinal anaesthesia. This audit evaluated prilocaine use in primary elective hip and knee arthroplasties and its association with same-day discharge.
Methods
A two-week, retrospective audit in a small district general hospital examined primary hip and knee arthroplasties performed under spinal anaesthesia. Fifteen cases (nine hips and six knees) met the inclusion criteria (primary hip and knee arthroplasties with a surgical time <80 minutes and <70 minutes, respectively). Cases using general anaesthesia were excluded. The primary outcome was the number of cases that could have used prilocaine. Secondary outcomes included time to mobilisation and timing of physiotherapy discharge.
Results
Only one of fifteen cases used prilocaine: the only case achieving same-day discharge. Based on surgical duration, all other cases could have used prilocaine. Among these fourteen patients, ten were discharged within 24 hours, two within 48 hours, and two after more than 48 hours. Reasons for prolonged stay included vasovagal episodes (3/15), uncontrolled pain (4/15), and patient preference (1/15). The average time from spinal administration to knife-to-skin was 23.6 minutes.
Conclusions
Despite patient eligibility for prilocaine, utilisation was minimal. Expanding prilocaine use appropriately may support day-case arthroplasty pathways and enhanced recovery. However, other unanticipated barriers to discharge were identified within pre-operative assessment (patient selection and setting expectations), peri-operative care (list order and analgesia) and post-operative recovery (physiotherapy). Addressing these factors would be crucial to optimise the benefits of prilocaine use.
Authors
Rosalind Rashid, James Cairn, Judit Eross
United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, United Kingdom