Surgeons, anaesthetists and pharmacists from Bristol’s Emersons Green NHS Treatment Centre
took part in this year’s British Association of Day Surgery Scientific Conference and walked away with a bronze and a gold award for their pioneering work.
Care UK’s clinical director of anaesthetics, Dr. Marco La Malfa, who is based at the centre, was presented with the gold award for his written presentation of a study into the benefits of using a standard dose of 40 mg 1% Chloroprocaine in people undergoing surgery under spinal anaesthesia.
Dr Malfa 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 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.”
In 2013, 1% Chloroprocaine became available in the UK and Dr La Malfa and his team began a trial in conjunction with Dr Robbie Erskine at Derby Nuffield NHS Hospital Trust. “We carried out a pilot of 50 patients in Bristol and 50 in Derbyshire,” he explained.
“Using the same protocol, the two centres did not liaise during the pilot so as not to inadvertently skew the results. We were delighted when, at the conclusion of the pilot, we found our results were identical.”
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 awake during the procedure and talking with the anaesthetists. They were also happy to be able to talk to the surgeon at the end of the surgery.
A second study at a Care UK centre also earned Dr La Malfa a bronze award. 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 stays, 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.”
Delegates at the Scarborough conference also heard from Emersons Green consultant ophthalmologist Dr Teresa Anthony who has developed a ground-breaking one-stop alternative to standard cataract surgery, and from pharmacist Tauheed Ahmed on enhancing discharge efficiency - prescription of discharge medication in clinic.
Hospital director Pamela Mackie said: “I am incredibly proud of our talented team. They have shown the medical community just how innovative and patient-centred our centre is and I think Bristol should be very proud of having such a pioneering facility on its doorstep.”