BJA Advance Access originally published online on October 25, 2006
British Journal of Anaesthesia 2006 97(6):869-873; doi:10.1093/bja/ael281
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Postoperative shoulder surgery initiative (POSSI): an interim report of major shoulder surgery as a day case procedure
1 Department of Anaesthesia, Addenbrooke's Hospital Cambridge CB2 2QQ, UK
2 Department of Anaesthesia, Royal Gwent Hospital Newport, UK
3 Discharge Liaison, West Norfolk Primary Care Trust Norfolk, UK
4 Clinical Effectiveness Department Kings Lynn, UK
5 Department of Orthopaedics Kings Lynn, UK
6 Department of Anaesthesia, Queen Elizabeth Hospital Kings Lynn, UK
*Corresponding author. E-mail: russonkim{at}doctors.org.uk
Background. There are logistical and financial advantages to undertaking shoulder surgery in a day case setting. However, this approach is limited by postoperative pain being inadequately controlled by oral medication alone. We describe a pilot study investigating the feasibility and acceptance of community based continuous interscalene brachial plexus blockade (CIBPB) to provide effective analgesia for day case shoulder surgery.
Methods. Phase 1 consisted of five patients who received CIBPB for shoulder surgery. Following an overnight hospital stay they were assessed for discharge home with the interscalene catheter in situ. Once the safety and feasibility of the approach was documented, five more patients were recruited to Phase 2. These patients had the adequacy of analgesia assessed in the postoperative period and were discharged home on the same day as surgery. A district nurse visited twice daily and removed the catheter on the third day. Patient satisfaction was assessed using a discovery interview.
Results. Nine of the 10 patients experienced good analgesia. One patient was re-admitted because the catheter fell out. No patient experienced complications and the discovery interviews showed that the patients were satisfied with their management and pleased to be treated as a day case.
Conclusions. POSSI proved that it was feasible to manage these patients in the community with support and training of the district nurses. Although extra community nursing hours are required, this technique has the potential for significant cost benefits with at least three bed days saved per patient.
Declaration of interest. Dr N.M. Denny is a paid consultant for B. Braun. Dr Sardesai, Dr Ridgway and Dr Russon have held the Clinical Fellow in Regional Anaesthesia post at Addenbrooke's Hospital 2003/4, 2004/5 and 2005/6 respectively. This post is partly funded by Abbott Laboratories Ltd. have held the Clinical Fellow in Regional Anaesthesia post at Addenbrookes Hospital in 2003/4 and 2004/5 respectively. No direct payment was received for this study.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Gonano, S. C. Kettner, M. Ernstbrunner, K. Schebesta, A. Chiari, and P. Marhofer Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery Br. J. Anaesth., September 1, 2009; 103(3): 428 - 433. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Fredrickson and D. J. Price Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5-6 root/superior trunk perineural ambulatory catheter Br. J. Anaesth., September 1, 2009; 103(3): 434 - 439. [Abstract] [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- POSSI; initiative or whim?
- Bruce Patrick Powell
- British Journal of Anaesthesia, 15 Dec 2006 [Full text]
- POSSI - Authors' response
- Kim E Russon, et al.
- British Journal of Anaesthesia, 4 Jan 2007 [Full text]