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Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade

Stephen M. Klein, MD^*, Roy A. Greengrass, MD FRCPC^*, Stuart A. Grant, MB CHB^*, Laurence D. Higgins, MD, Karen C. Nielsen, MD^* and Susan M. Steele, MD^*

^* From the Departments of Anesthesiology and
Surgery, Duke University Medical Center, Durham, NC, USA.

Address correspondence to: Dr. Stephen M. Klein, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. Phone: (919) 688-2056; Fax: (919) 668-2081; E-mail: klein006{at}mc.duke.edu

Purpose: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case illustrates the use of lumbar plexus and sciatic nerve peripheral catheters for major knee surgery using intermittent bolus dosing for outpatient analgesia.

Clinical features: A 20-yr-old male presented for multi-ligamentous knee reconstruction (posterior collateral ligament and revision anterior collateral ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general anesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0.2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 ml in each catheter (four injections total). This provided 96 hr of analgesia and low supplemental opioid use.

Conclusion: The use of a lumbar plexus and sciatic nerve peripheral catheter offered an alternative to conventional pain control that worked well in the ambulatory setting. By providing prolonged unilateral lower limb analgesia, extensive knee surgery was performed that would normally require a hospital stay for pain control. Using a bolus dosing method the risk of local anesthetic complications occurring outside of the hospital with a continuous infusion was minimized.

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