REPAIR OF RUPTURED TENDO-ACHILLES (TA) UNDER LOCAL ANAESTHETIC (LA)

Abstract

There is no consensus on the management of TA rupture. For operative management, TA have been repaired under general/spinal anaesthetic (GA) or LA. LA repair may be at least as effective and can reduce anaesthetic complications. LA can be performed as a day case and could have significant cost savings.

We retrospectively reviewed 80 patients (sample size 120), during the five year period 2001–2005 at Nelson Hospital, who’s ruptured TA was repaired under general anaesthetic (GA) or local anaesthetic (LA). All patients reviewed were at least six months post-op. We assessed at a clinic their long-term outcome, including pain and function. This included their range of motion and strength. Epidemiological data including risk factors was collected. Patients completed a Foot and Ankle questionnaire developed by the American Academy of Orthopaedic Surgeons. Complications such as infection or nerve damage were noted. Further patients are currently being seen to increase sample size.

Of the 80 TA that were repaired, 51 (64%) were repaired under GA, 29 (36%) under LA. Results thus far show similar levels of patient satisfaction. 82% of GA patients and 83% of LA patients reported no pain. Patient-reported weakness was 27% (GA) and 24% (LA). Single leg hop distance comparing injured with uninjured was 94% (GA) and 91% (LA). Maximum calf raises in 30 seconds comparing injured with uninjured was 84% (GA) and 82% (LA). Calf diameter on the injured side was 97% (GA) and 96% (LA) compared with the uninjured. The average theatre time was 38 minutes (LA) compared with 65 minutes. LA patients spent on average 0.26 days in hospital compared with 1.2 days, reflecting a greater proportion of day cases. LA patients had a quicker return to work, average 21 days versus 30. Complications in the GA group, included two deep vein thromboses and two pulmonary emboli. One patient from each group had a re-rupture. Results will be reviewed and further statistical analysis done once further patients have been seen.

There is no disadvantage in repairing a ruptured TA under LA with regards to long-term pain, function and patient satisfaction. LA repair avoids anaesthetist involvement and anaesthetic complications. Repair under LA results in significant cost savings due to less theatre time, a shorter hospital stay and a quicker return to work.