| Patient Selection | No specific inclusion or exclusion criteria |
| Anaesthetic Techniques | • Short acting general anaesthetia technique such as TIVA with pEEG monitoring • +/-Adductor canal block – 10-20ml 0.25% bupivacaine |
| Surgical Technique | • Infiltration around tendon harvest site + arthroscopic port sites with 0.125% Levobupivacaine up to a total dose of 2mg/kg taking into account the bupivacaine used for adductor canal block • Intra-articular morphine 10mg |
| Peri-Operative Analgesia | • Pre-operative: oral paracetamol 1g (weight <50kg 500mg) • Intraoperative: iv NSAID if no contraindication. IV paracetamol if 4 hrs since last dose. Iv Fentanyl titrated at end (avoid long-acting opiate) • Recovery: IV fentanyl and/or oral morphine • Post-operative: regular oral paracetamol and codeine + prn oral morphine |
| Take Home Medication | As per GIRFT day surgery TTO guideline for adults (weight >50kg) Able to take NSAIDs • Paracetamol 1g QDS (32 tablets, 500mg each) • Ibuprofen 400 mg QDS (24 tablets, 400mg each) • Codeine 30-60mg QDS (28 tablets, 30mg each) • Macrogol 1 sachet BD Unable to take NSAIDs • Paracetamol 1g QDS (32 tablets, 500mg each) • Morphine sulphate oral solution 10-20 mg QDS (1 bottle 100ml/200mg) • Ondansetron 4mg TDS (6 tablets, 4mg each) • Macrogol 1 Sachet BD |
| Organisational Considerations | • X-ray requested before patient leaves theatre (ideally on day of surgery but can be within 2 weeks; must not delay discharge) • IV antibiotic prophylaxis as per Trust antimicrobial guidelines • Antibiotic wrap for ACL graft – 500mg vancomycin in 100ml 0.9% NaCl mixed in a kidney dish and soaked into a small swab |
| Anticipated Day Case Rate | >95% |