Achilles Tendon Repair

Anesthesia Implications

Position: Prone, arms extended and flexed (“superman”)
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes
Tourniquet Use: Yes
Blocks: Popliteal

Approach – GETT with a peripheral nerve block is recommended due to prone position and potential for a long surgery. Spinal or epidural can used, but it is rare.

Emergence – A brace and potentially a device (surgeon specific) will need to be placed on the patient after the surgery is completed. Avoid emergence until that’s happened!

Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.

Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2)

Achilles tendon tear often occurs during a sporting activity that requires jumping or stopping suddenly, but can also occur as a result of an underlying disease or trauma.

Fluoroquinolone antibiotics (such as cipro and levaquin) can cause a weakening of large tendons. Achilles tendon rupture can be more common in patient’s taking these antibiotics.

There are two main types of Achilles tendon repair surgical techniques: open or percutaneous. In either technique the main objective is to sew the broken ligament back together.