A Series of Peripheral Nerve Blocks Combined With Spinal Anesthesia Is Associated With Improved Outcomes Following Total Knee Arthroplasty: A Retrospective Study

TL;DR

Using a new series of nerve blocks with spinal anesthesia during knee surgery improves recovery by reducing pain, opioid use, and hospital stay.

Contribution

A novel preoperative peripheral nerve block series combined with spinal anesthesia is introduced for total knee arthroplasty.

Findings

nPNBs-SA patients had lower pain scores and shorter PACU and hospital stays compared to PNBs-GA patients.

nPNBs-SA patients showed greater ambulation distance and non-opioid use post-surgery.

Opioid use was lower in nPNBs-SA patients, though not statistically significant.

Abstract

Background

Peripheral nerve blocks (PNBs) are commonly used in conjunction with general anesthesia (GA) or spinal anesthesia (SA) during total knee arthroplasty (TKA). SA is associated with reduced complications, hospital length of stay (LOS), and mortality. PNBs improve the time to discharge readiness and patient satisfaction. In 2018, we implemented a set of novel, preoperative, single-injection PNBs used with SA and intraoperative sedation. We hypothesized this regime would reduce postoperative pain, opioid use, and hospital and post-anesthesia care unit (PACU) LOS and would improve ambulation.

Materials and methods

This retrospective study compared pain scores, hospital and PACU LOS, opioid consumption, postoperative nausea and vomiting, and postoperative ambulation between two TKA patient groups: patients who received a series of preoperative PNBs and GA (PNBs-GA) and patients who received a novel series of preoperative PNBs and SA (nPNBs-SA).

Results

nPNBs-SA patients demonstrated lower average and maximum pain scores (p<0.001), shorter PACU and hospital LOS (p<0.001), and greater ambulation distance (p=0.047) compared to PNBs-GA patients. After controlling for relevant covariates, there was no significant difference in ambulation distance between the groups (p=0.519). nPNBs-SA patients demonstrated greater postoperative non-opioid use (p=0.001) and lower but not significantly different postoperative opioid use (p=0.064) compared to PNBs-GA patients.

Conclusions

Our novel series of PNBs with SA for TKA patients may reduce postoperative pain and opioid use while also improving ambulation and shortening hospital and PACU LOS.

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