Document Type

DNP Project

Publication Date

2020

Disciplines

Nursing

Abstract

Background: The number of annual total knee arthroplasties (TKA) had doubled over the last decade. Although this procedure treated chronic pain and restored mobility from end-stage osteoarthritis and other etiologies, it was associated with acute moderate-to-severe pain in the early postoperative period. Various analgesic techniques such as local infiltration, neuraxial blocks, and peripheral nerve blocks (PNB) were used in conjunction with multimodal anesthesia to prevent postoperative pain following TKA. The large variety of analgesic regimens accompanied with differing institutional and provider preferences challenged the ability to standardize a postoperative analgesic technique for TKA.

Local Problem: Anesthesia providers at the project site often utilized the adductor canal block (ACB) alone or combined ACB and popliteal sciatic nerve block (PSNB) techniques for postoperative analgesia following TKA. However, it was unclear which technique was superior.

Purpose: To understand the analgesic efficacy between ACB and combined ACB/PSNB following TKA.

Methods: A retrospective chart analysis on 100 subjects that received ACB alone or ACB/PSNB for TKA in 2019. Pain was assessed upon post anesthesia recovery unit (PACU) admission, at 12 hours, and at 24 hours. Total opioid consumption was recorded for the first 24 hours. Length of hospitalization (LOH) was recorded per documentation.

Results: Pain during PACU stay, pain at 12 hours postoperatively, and opioid consumption at 12 hours postoperatively were all significantly lower in the combined ACB/PSNB group (P = 0.0182, 0.0488, 0.0106 respectively). Pain and opioid consumption at 24 hours and LOH were not significantly different between the two groups.

Conclusion: Combined ACB/PSNB therapy decreased pain and opioid consumption in the first 12 hours postoperatively following TKA. Large randomized controlled trials (RCT) need to be performed to deem the efficacy and incidence of related complications between these two blocks.

Keywords: Adductor canal block, sciatic nerve block, femoral nerve block, knee, total knee arthroplasty

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Copyright Tierra Penick

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