MICHAEL HOCKINGS & MARY STOCKER

(Original article published 2013, updated 2020)

Patient Selection

• No specific selection criteria

Anaesthetic Techniques

• Short acting general anaesthetic:
  We use TIVA with propofol and remifentanil
  
  
• Saphenous nerve block which provides a slightly less reliable sensory block than a femoral nerve block but has the advantage of no motor block. This is the preferred technique surgically to enable full weight bearing immediately post operatively
  30 mls. 0.25% Bupivacaine (reduced to 1mg/kg if under 75kg)

Surgical Technique

• Infiltration of local anaesthetic into the skin around the harvest site of patellar tendon or hamstrings and the arthroscopic portals
  30mls of 0.25% Bupivacaine total (reduced to 1mg/ kg if under 75kg)

Peri-operative analgesia

• Pre-operative: oral paracetamol and ibuprofen

• Intra-operative: iv fentanyl

• Post operative: regular paracetamol and ibuprofen

• Rescue intravenous fentanyl or oral morphine if required

Take Home Medication

• Paracetamol 500 mg/ codeine 30mg po qds, laxido 1 sachet bd, plus ibuprofen 600 mg po qds

Organisational Issues

• Surgeon must write x- ray request form before patient leaves theatre

• Intravenous teicoplanin 400 mg on induction avoids the need for further post operative doses of antibiotics

• Physiotherapist must be available to see patient preoperatively or immediately post operatively to fit knee brace and aid timely discharge

Anticipated Day case Rates

• 90%