A novel distraction technique to facilitate daycase paediatric surgery under local anaesthesia

With increasing demands on plastic surgery services within the NHS currently, theatre utilisation statistics and efficiency are being highlighted in an effort to maximise throughput and reduce waiting lists. Elective paediatric lists in our hospital are infrequently available and therefore it can be logistically challenging to perform paediatric cases during school holidays. Together with risks of anaesthesia and availability of specialist anaesthetists and ODPs these factors add to theatre delays and inefficiencies in theatre utilisation and often time is lost due to such non-surgical factors. We put forward a novel, patient-friendly and effective means of achieving good anaesthesia, maximising theatre time through use of local anaesthesia (faster turn-around time vs. general anaesthesia), shorter in patient stays and subsequent cost-effectiveness, and overall positive psychological reinforcement for children. Various methods described in the literature have been used to reduce paediatric anxiety pre-operatively however, there are very few which facilitate surgery and reduce anxiety intra-operatively. The use of such distraction techniques for young children in our experience demonstrated to reduce the anxiety of children undergoing minor surgeries and facilitated the administration of anaesthesia to them. We accept this cannot be applied to all paediatric cases, however this model can be a useful adjunct in theatre scheduling in selected cases based on the child’s individual needs and best interests (Figure 1).