IADR Abstract Archives
Donor Site Local Anaesthetic Wound Infusion as an Opioid Sparing Mechanism in Fibula Free Flap Reconstruction of the Facial Bones and its Effect on Postoperative Delirium.
Objectives: Enhanced recovery of head and neck cancer patients after major free flap surgery requires adequate analgesia but over reliance on opioids should be avoided to minimise their associated complications. The objectives of this study were to investigate the efficacy of a local anaesthetic (LA) donor site wound infusion as an opioid sparing mechanism and its influence on postoperative delirium, length of Intensive Care Unit (ICU) stay and overall length of hospital stay.
Methods: This was a retrospective case controlled cohort study. All patients who underwent fibula free flap reconstruction of their facial bones by a single maxillofacial surgeon between September 2015 and September 2020 were included. A donor site LA infusion protocol was introduced midway through the study period. Patient data was retrieved from a prospectively maintained free flap database and from electronic patient records. Outcomes for patients treated with the donor site LA protocol were compared with those treated prior to the introduction of the protocol.
Results: There were 62 fibula free flap reconstructions in 61 patient. There were 37 (61%) male and 24 (39%) females. The mean age was 58 years (Range 11-84). 43 patients received the LA wound infusion and there were 19 controls treated by a standard postoperative analgesia regimen without the use of the LA infusion. There were no complications associated with either placement of the catheter or the LA infusion. The LA infusion resulted in a significant reduction in opioid requirements (p<0.0001) and postoperative delirium (p=0.003). There was no difference in ICU stay or overall hospital stay.
Conclusions: We recommend the use of a donor site local anaesthetic wound infusion catheter in fibula free flap reconstruction of the facial bones. The catheter is easy to place and safe. The infusion results in a significant reduction in opioid requirements and post-operative delirium.
Methods: This was a retrospective case controlled cohort study. All patients who underwent fibula free flap reconstruction of their facial bones by a single maxillofacial surgeon between September 2015 and September 2020 were included. A donor site LA infusion protocol was introduced midway through the study period. Patient data was retrieved from a prospectively maintained free flap database and from electronic patient records. Outcomes for patients treated with the donor site LA protocol were compared with those treated prior to the introduction of the protocol.
Results: There were 62 fibula free flap reconstructions in 61 patient. There were 37 (61%) male and 24 (39%) females. The mean age was 58 years (Range 11-84). 43 patients received the LA wound infusion and there were 19 controls treated by a standard postoperative analgesia regimen without the use of the LA infusion. There were no complications associated with either placement of the catheter or the LA infusion. The LA infusion resulted in a significant reduction in opioid requirements (p<0.0001) and postoperative delirium (p=0.003). There was no difference in ICU stay or overall hospital stay.
Conclusions: We recommend the use of a donor site local anaesthetic wound infusion catheter in fibula free flap reconstruction of the facial bones. The catheter is easy to place and safe. The infusion results in a significant reduction in opioid requirements and post-operative delirium.