Can an olecranon bursectomy be performed under Monitored Anesthesia Care (MAC) and local anesthesia?

Olecranon Bursectomy Under MAC and Local Anesthesia

Yes, an olecranon bursectomy can be safely and effectively performed under monitored anesthesia care (MAC) and local anesthesia. This approach is appropriate for most patients requiring this procedure and offers advantages over general anesthesia in terms of recovery time and reduced anesthetic risk.

Anesthetic Approach for Olecranon Bursectomy

Recommended Anesthetic Technique

• Local anesthesia with MAC is a suitable approach for olecranon bursectomy, providing adequate pain control while maintaining patient consciousness 1
• The procedure involves local anesthetic infiltration beyond the lesion area, followed by careful surgical debridement and removal of the entire bursa 1
• MAC allows for appropriate sedation, anxiety control, and pain management while maintaining the patient's ability to protect their airway and respond to commands 2

Benefits of MAC with Local Anesthesia

• Reduced risks compared to general anesthesia, particularly important for patients with comorbidities 3
• Faster recovery and earlier discharge, improving patient satisfaction 2
• Avoidance of airway instrumentation and potential complications associated with general anesthesia 3

Specific Anesthetic Considerations

• Local anesthetic should be administered using incremental injections after aspiration to avoid intravascular injection 3
• Maximum safe dose of lidocaine with epinephrine is 7 mg/kg, while lidocaine without epinephrine is limited to 4.5 mg/kg 3
• For patients with true lidocaine allergy (rare), ester-type local anesthetics can be used as alternatives 3

Procedural Considerations

Surgical Technique

• Complete olecranon bursectomy with debridement can be performed effectively under local anesthesia 1
• Careful identification and protection of veins and nerves is essential during the procedure 1
• The entire bursa should be identified and removed to prevent recurrence 1, 4

Special Populations

• For anxious or claustrophobic patients, general anesthesia may be considered as an alternative 3
• In patients with sleep-disordered breathing, modifications to the anesthetic technique may be necessary, including use of short-acting agents and minimal opioids 3

Emerging Techniques

• Wide-awake local anesthesia with no tourniquet (WALANT) has been successfully used for elbow procedures including olecranon fracture fixation, suggesting its potential application for bursectomy 5
• Endoscopic olecranon bursal resection has shown excellent outcomes with no recurrences in both septic and aseptic bursitis cases 4

Postoperative Management

• Early functional aftercare without splinting is recommended following drain removal 1
• Elastic bandage application for approximately 2 days, followed by drain removal 1
• Wound assessment and appropriate antibiotic therapy in cases of septic bursitis 1

Potential Complications

• Wound healing problems and recurrence are possible complications but can be minimized with proper technique 4
• Fistulae and wound dehiscence have been reported but are relatively rare 1
• Careful monitoring for signs of local anesthetic systemic toxicity is essential, particularly when using higher volumes 3

By following these guidelines, olecranon bursectomy can be safely and effectively performed under MAC with local anesthesia, providing good surgical outcomes while minimizing anesthetic risks.