New York, NY—April 19, 2018
Performing ambulatory knee surgery while the patient is awake is feasible – both in patients who use audiovisual devices and those who don’t – results of a poster presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine suggest.
Neuraxial anesthesia, a type of regional anesthesia that targets nerves at the spinal level, is used in many ambulatory knee surgeries, explained the investigators. Anesthesiologists use a neuraxial block combined with sedative medication to keep the patient calm. But, more sedative use is linked to its own set of side effects, thus making it important to investigate how to keep exposure down.
"Using headphones or audiovisual devices may not only lower anxiety but can limit sedation requirements during surgery under neuraxial anesthesia," said Stavros Memtsoudis, MD, PhD, FCCP, principal investigator and senior scientist within the Department of Anesthesiology, Critical Care & Pain Management at Hospital for Special Surgery (HSS). Neuraxial anesthesia is a type of regional anesthesia that targets nerves specific to the surgery site.
"Reducing or eliminating sedation may lead to improved perioperative care," explained Dr. Memtsoudis.
To determine if audiovisual devices could impact anxiety levels in patients who received minimal sedation, the investigators randomized 26 patients undergoing primary, ambulatory arthroscopic meniscectomy using neuraxial anesthesia with audiovisual device (n=13) and without an audiovisual device (n=13).
Patients received 2 mg of midazolam before placement of the regional anesthetic medication and could request more sedation at any time, noted the researchers. To gauge satisfaction, patients answered questionnaires and anesthesiologists and surgeons provided feedback on their experience with the audiovisual devices.
No differences in post-operative pain scores or opioid use were observed between the two groups, and no complications occurred. Among the patients, 5 who received no audiovisual device and 2 patients with an audiovisual device requested additional sedative. No difference was seen in either state or trait anxiety scores between groups either before or after surgery. Patients in both groups reported equally high satisfaction following surgery. Providers reported a positive experience with audiovisual device use.
"We demonstrated that performing ambulatory knee surgery under regional anesthesia in awake patients is feasible – with and without the use of audiovisual devices," said Dr. Memtsoudis. "Future studies should use greater sample sizes to determine if use of these devices can reduce sedative medication use and have an impact on outcomes."
Pichler L, Lee KL, DeMeo D, Fields K, Moerwald EE, Cozowicz C, Memtsoudis SG. "The feasibility of awake ambulatory knee surgery under regional anesthesia with and without the use of audiovisual devices." Presented at: 2018 World Congress on Regional Anesthesia and Pain Medicine; April 19-21.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients from 80 countries and performed more than 32,000 surgical procedures. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute was formed in 2015 to realize the potential of new drugs, therapeutics and devices; the global standard total knee replacement was developed at HSS in 1969, and in 2017 HSS made 130 invention submissions (more than 2x the submissions in 2015). The HSS Education Institute provides continuing medical curriculum to more than 15,000 subscribing musculoskeletal healthcare professionals in 110 countries. Through HSS Global, the institution is collaborating with medical centers worldwide to advance the quality and value of care and to make world-class HSS care more accessible to more people.