KT- 1000 Measurements, Joint Injection, Femoral Nerve Block

FIRST, Is it the correct side? Your initials should be visible on the correct knee. It is important to document the instability by the examination under anesthesia. I also look for the associated laxities, such as, postero-lateral and posterior cruciate.

I then measure the AP laxity on both knees with the KT -1000. This is entered on the computer data form. I compare the manual maximum on the normal side with the manual maximum obtained at the end of the case with the KT-S.

Over the past year we have changed our pain management to be pre-emptive. There have been a number of studies to show that there is less post-op pain, if the patient receives the blocks before the incision is made. The best pre-emptive block is the spinal. You must be aware to give the patient enough pain medication before the spinal wears off, or this is just like waking up from the general with no pain medication on board.

Our routine now is to inject 20cc of Marcaine 0.25% with epinephrine and Morphine 2 mgm into the joint before the prep. A femoral nerve block is done by the anesthetist with a nerve stimulator using 20 cc of Marcaine 0.25% with epinephrine. The anesthetist gives 30 mgm Torodol i.v. and 1 gm Ancef i.v.

We Now are Ready to Prep and Drape

• I put the tourniquet on and use it only to do the graft harvest.

• I use a Linvatec pump. This works in coordination with the Apex driver system for the shaver and burrs.

• I use 1 amp of adrenaline in 3 litre bags of normal saline. In a routine case we use 4 to 5 bags of saline. ( 12-15 litres)

• I use a low profile leg holder placed around the tourniquet. The leg is flexed over the side of the bed.