ESRA Academy. Pepper W. Sep 8, 2016; 138584; 0461 Topic: Preoperative Considerations/ Safety /Complications
Warwick Pepper
Warwick Pepper

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Background and Aims:

At our orthopaedic tertiary referral centre, patients undergo prolonged orthoplastic surgery for chronic osteomyelitis with free-flap grafting.  These operations typically last in excess of 8 hours.  Our technique of choice for anaesthsia is an epidural with light sedation, utilizing audiovisual distraction (AVD) with a tablet computer to allay anxiety.  We performed a patient survey to assess the patients' experience and overall satisfaction with our technique.


Consecutive patients scheduled for elective osteomyelitis and free flap surgery were prospectively offered our epidural/sedation/AVD technique.  These patients were given an internet-connected tablet computer with noise-isolating headphones to use before, during and immediately after surgery.  Minimal sedation using propofol was titrated to patients’ requirements.  Questionnaires were issued in the immediate post-operative period assessing the patient experience with emphasis on anxiety levels, comfort, overall satisfaction and comparison to previous general anaesthetics (GA).


12 patients were recruited in to the study.  100% of patients stated that they were either comfortable or very comfortable during surgery.  Where patients were anxious, AVD was found to improve anxiety levels in all cases. 100% of patients were very satisfied with technique and would recommend it to other patients.  Of the 11 patients who had received a GA previously, 10 patients stated that our technique was better than a GA, 1 stated no difference. 


The use of AVD with our epidural/sedation technique for osteomyelitis surgery has had a very positive impact on patients' experience, the majority of patients preferring the technique to GA.  This clinical service improvement deserves further study and funding.   

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