Day surgery for anterior cruciate ligament reconstruction in children: A prospective study on feasibility and satisfaction

Abstract

Purpose To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. Methods A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients’ satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31. Results Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously. Conclusion This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner. Level of evidence IV, prospective case series.

Combined femoral–obturator–sciatic nerve block has superior postoperative pain score and earlier ambulation as compared to spinal anaesthesia for arthroscopic anterior cruciate ligament reconstruction

“…Spinal anaesthesia may not be ideal for daycare surgery. Peripheral nerve blocks can make daycare surgery feasible as only one limb is anaesthetised [3, 17].…”

“…Day‐care ACLR often uses general anaesthesia with or without peripheral nerve blocks, as it may not be possible to send the patient home on the same day after the surgery using CNB [1]. Advantages of peripheral nerve blocks include better postoperative pain relief, opioid‐sparing analgesia, and lesser systematic side effects such as nausea and vomiting [3, 5, 14, 15, 17, 30]. A combined femoral, sciatic, and obturator nerve block provide adequate blockade of all sensory and motor innervations to structures involved in ACLR surgery, including the medial hamstring tendons which are used as the autograft [14, 15, 17, 22, 24].…”

Investigation on the Needs of Preoperative Health Education of Parents, Whose Children Undergoing Day Surgery

“…In this study, parents' demand for health education ranked rst when they made an appointment for day surgery. Education at this time can help parents have better operation cognition and psychological preparation, and reduce the no-show rate of day surgery, preoperative anxiety and postoperative complications [9] . Therefore, health education before pediatric day surgery should be moved forward, which can be moved forward to the appointment of day surgery, so as to increase the digestion time of parents about day surgery related knowledge, and relieve their tension and anxiety [10] .…”