Haggis Infusion of Bupivicaine 0.5% for Donor site free flap OMFS Reconstructions

SJH Theatres and Anaesthetics
NHS Lothian

Objectives

Protocol for Infusion pumps

Scope

Microvascular free tissue transfer has become the gold standard for reconstruction after ablative treatment for head and neck cancers. Many donor sites can be utilised depending on the tissue required i.e radial free flap forearm flap; ALT flap; DCIA flap; fibula flap & scapula flap. Post-operatively the donor harvest site is often the main painful part of the procedure.

Bupivicaine infusions are beneficial for some of the more painful flap harvest sites i.e fibula and scapula flaps & can be sited prior to wound closure by the surgeon. an 18G epidural catheter is placed into the donor site and brought out through the skin lateral to the wound. The catheter is secured to the skin by way of an Epic dressing which is further secured with a Tegarderm dressing. 

Equipment required

  • B Brain 400mls Was pump (ref: 4440003) stored in theatres stores (otherwise known as a Haggis)
  • 50ml syringe
  • Small sterile drape
  • Traysin container
  • 400ms 0.5% Bupiviciane (racemic- no need to use lego-bupivicaine since it's going to be infused at 5mls/hr)
  • Sterile gloves
  • 18G epidural set + 18G Epifix dressing and Tegaderm dressing 

Technique

Technique

  • Place sterile drape on counter on trolley
  • Place Traysin on sterile drape
  • Place 400mls Bupivicaine 0.5% into Traysin
  • Draw this up in 50mls syringe full and inject into haggus- ensure the clip is open
  • Once haggis is filled with 400mls of Bupivicaine close clip (on administration tubing) hand over to scrub in a sterile way
  • Finally, hand in 18g Touhy needle, epidural catheter an Epifix to scrub nurse
  • The Haggis will infuse the local anaesthetic at 5mls/hr. 

Editorial Information

Last reviewed: 01/01/2015

Author(s): L Carragher, C Gardner.

Approved By: Uploaded by M Crawford

Reviewer name(s): N Masood.