Acute Pain, Knee Osteoarthritis, Regional Anesthesia Morbidity
Conditions
Brief summary
This is a retrospective study looking at patients who received a nerve block for surgery and assessing pain after the nerve block resolves, with or without an educational intervention, over two periods of time.
Detailed description
Regional anesthesia (RA) is a vital tool that can serve as the primary anesthetic or as part of a multimodal perioperative pain regimen. RA is strongly associated with decreased acute and persistent pain and opioid consumption postoperatively. However, some patients experience an acute worsening of pain into the severe range around the time of RA resolution, also known as "rebound pain" (RP). The incidence of RP has been reported as high as 40-50% after a single shot nerve block for patients undergoing ambulatory surgery. This retrospective study aims to look at patients who received a nerve block for surgery and assessing pain after the nerve block resolves in the presence and absence of certain interventions, such as a multidisciplinary educational intervention. The investigators will assess patients who received a primary total knee arthroplasty who received a single shot adductor canal nerve block, received pericapsular injection by the surgeon, and had a length of stay \> 16 hours.
Interventions
OTHEREducational intervention
Multidisciplinary educational intervention was performed by orthopedic, anesthesia, and nursing team. This included a discussion of the patient's pain plan and a patient visit.
Sponsors
Brigham and Women's Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Inclusion criteria
* primary total knee arthroplasty * received an adductor canal nerve block * received pericapsular injection by surgeon intraoperatively * admitted for overnight stay and \> 16 hours post-nerve block
Exclusion criteria
* age \< 18 * prior total knee arthroplasty on ipsilateral knee
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in maximum pain score, 0-10; (0 = no pain, 10 = worst pain) | 6-24 hours | Difference in maximum pain score, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average pain score 0-10; (0 = no pain, 10 = worst pain) | 6-24 hours | Difference in area under the curve of pain scores, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts (educational intervention and non-educational intervention time periods) |
| Difference in incidence of rebound pain | 6-24 hours | Difference in incidence pain score ≥ 7 between 6-24 hours post nerve block between the two cohorts |
| Comparison of evening opioids given | 6-24 hours | Comparison of if evening opioids were or were not given (yes/no) between the two cohorts |
| Difference in total opioids given | 6-24 hours | Difference in total opioids given (mEq of morphine) between the two cohorts |
| Difference in length of stay | 0-2 years | Difference in length of stay (days) between the two cohorts |
Contacts
PRINCIPAL_INVESTIGATORYun-Yun K Chen, MD
Brigham and Women's Hospital
Outcome results
None listed