Jul 03, 2014
Care UK, in partnership with the Derby Nuffield Hospital NHS Trust, carried out a study into the use of a new generation of local anaesthetics for spinal anaesthesia. The pilot carried out in Derby and Care UK’s Emersons Green NHS Treatment Centre in Bristol took the gold award for the study into the benefits of using a standard dose of 40 mg 1% Chloroprocaine in people undergoing day case surgery under spinal anaesthesia.
Care UK’s clinical director of anaesthetics, Dr Marco La Malfa, who is based at the Bristol centre, explained: “We prefer to use local anaesthetics and/or regional nerve blocks when possible to remove the unpleasant effects and long down-time associated with general anaesthetics and/or to control the post-operative pain.
“We have always used local anaesthetics for spinal anaesthesia and, whilst medically very effective, often they were very unpredictable in terms of the duration of the block. For some, the effects could go on for three or more hours, delaying the time patients could begin to become mobile and leave the centre, or causing prolonged urinary retention followed by patient admission at the ward.”
The Derby team, led by consultant anaesthetist Dr Robbie Erskine, and the Bristol team carried out the pilot on 50 patients in each centre. Using the same protocol, they did not liaise during the pilot study so as not to inadvertently skew the results but they were delighted when, at the end of the trial, the results were the same.
The surgical times were between three and 52 minutes and the average patient discharge time, after the end of surgery, was 83.5 minutes. Patient satisfaction levels were high and patients reported they were happy to be able to talk to the anaesthetist during the procedure and with the surgeon directly afterwards.
Dr Erskine said: “This pilot and further data collected since demonstrates that this new drug allows the anaesthetist to target the anaesthetic to fit the length of the procedure which is particularly important in Day Stay Surgery."
"I hope to introduce this new spinal anaesthetic to our local Trust to allow its benefits to be enjoyed by the wider population of Derbyshire.”
Dr La Malfa also received a bronze award for his report into a pilot carried out at Care UK’s Barlborough NHS Treatment Centre in Chesterfield.
The 50-patient trial examined the use of a regional anaesthetic block for shoulder surgery, avoiding the utilisation of general anaesthesia
Dr La Malfa said: “It has been very successful: normally this type of surgery is performed under general anaesthesia in combination with a regional nerve block. We have proved that it is possible to perform shoulder surgery safely under nerve block only and with the patient awake during the duration of the surgery. There was high patient acceptance, shorter hospital stay, less total non-surgical intraoperative time, fewer postoperative interventions and no unplanned admissions or re-admissions for problems.
“Patients reported that they had little or no pain and, for the more nervous patients, we were able to administer a low dose of sedative to keep them calm during the procedure.”
Barlborough hospital director Gill Barnes said: “I am delighted for the team, and I think it is good news for the county that the NHS and the independent healthcare sector are working together to create such ground-breaking methods of improving patient comfort and safety.
“The lessons learned in these pioneering studies will be used nationwide across Care UK’s services and I am very proud that they had their origins here in Derbyshire.”
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