Over the last two years I have introduced an Enhanced Recovery After Surgery (ERAS) pathway for anterior cruciate ligament reconstruction surgery at Sportsmed Hospital. This is a patient focused evidence-based team approach to ACL reconstruction that reduces pain and speeds up recovery. Every aspect of patient care has been carefully evaluated and the patient is involved as an active participant in the process.
As a surgeon the humbling thing is that surgical technique plays a relatively minor role in enhanced recovery pathways and these results are mainly achieved by assembling a dedicated multidisciplinary team focused on providing the best patient care and experience. The key factors involved are specialised anaesthetic techniques, multimodal opioid sparing pain relief, and modern nursing and physiotherapy care that reduces pain that enables early walking.
The process starts well before surgery with education. My team and I will discuss your expectations and ensure you are fully informed and prepared for surgery. On the day of surgery you will be advised to remain hydrated continuing clear fluids until 3 hours before the procedure. Most patients will have a general anaesthetic supplemented by a muscle sparing nerve block as well as infiltration of local anaesthetic and medicine to reduce inflammation around the knee. Tourniquet use is minimised and drains are avoided. My experience has been that the use of a patella tendon graft also helps as the nerve block provides better pain relief to the relevant area of the knee.
Patients should wake up with minimal pain. Oral pain relief is commenced early, with minimal opioids to reduce nausea and sedation. After one or two hours patients are assisted to walk. This early movement helps prevent the joint becoming stiff and sore. Splints are not used and while crutches are available they are often not needed. Pain is usually manageable with oral pain relief and strong narcotics are not usually required.
The key benefits of this approach have been shown to be:
- Less post-operative pain
- Reduced opioid consumption
- Reduced recovery time
Using this approach some patients are able to go home the same day if they choose to. An overnight stay in hospital is also a popular option. This can of course be adjusted based on a patient’s individual circumstances and recovery. There will always be some individual variation.
An example of what can be achieved is shown in this video:
Many other factors contribute to the success of enhanced recovery pathways. Every member of the team is involved including the patient, family, surgeon, anaesthetist, physiotherapist, nurses and admin staff. We have carefully evaluated every aspect of the patient journey to provide the best patient care and experience.
If you would like to discuss anterior cruciate ligament reconstruction with Dr Bauze then send us an email using the form on this page or call 81301259
For more information on ACL reconstruction click here
Reference
Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery. Hampton H, Torre M, Satalich J, Pershad P, Gammon L, O'Connell R, Brusilovsky I, Vap A.Orthop J Sports Med. 2022 Nov 23;10(11)
