Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade

Purpose: Major reconstructive surgery oi the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve bl ockade is an alternative method of pain control but is seldom used in the a mbulatory setting. This case illustrates the use of lumbar plexus and sciat ic nerve peripheral catheters for major knee surgery using intermittent bol us dosing for outpatient analgesia. Clinical features: A 20-yr-old male presented for multi-ligamentous knee re construction (posterior collateral ligament and revision anterior collatera l ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general a nesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0 .2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 mi in each catheter (four injections total). This provided 96 hr of anal gesia and low supplemental opioid use, Conclusion: The use of a lumbar plexus and sciatic nerve peripheral cathete r offered an alternative to conventional pain control that worked well in t he ambulatory setting. By providing prolonged unilateral lower limb analges ia, extensive knee surgery was performed that would normally require a hosp ital stay for pain control. Using a bolus dosing method the risk of local a nesthetic complications occurring outside of the hospital with a continuous infusion was minimized.