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.