Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block

Júnior, Lúcio Honório de Carvalho; Temponi, Eduardo Frois; Paganini, Vinícius Oliveira; Costa, Luciane Rezende; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques

doi:10.1590/1806-9282.61.01.040

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…On the other hand, these parameters are not well studied for the management of acute exacerbations of chronic neuralgiform pain. Most data on the relationship between PNB use and length of stay comes from orthopedic surgery studies that evaluate the benefits of PNBs in the setting of postoperative pain . A review in the Cochrane Database showed very‐low‐quality evidence for PNBs to decrease length of stay and low‐quality evidence to increase patient satisfaction when compared to systemic analgesia alone in the setting of elective hip replacement …”

Section: Discussionmentioning

confidence: 99%

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

2020

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Background Peripheral nerve blocks (PNBs) are used for a wide spectrum of headache and facial pain disorders. The objective of this case report is to highlight the erector spinae plane (ESP) block, which has recently been reported to successfully treat headache. Case Presentation A 70‐year‐old man with a history of mild to moderate headaches, previously ruptured aneurysm, and right pterional craniotomy and clipping of an anterior communicating artery aneurysm presented with exacerbation of chronic post‐surgical scalp pain and severe headache with nausea. Results of the physical examination were not consistent with cellulitis of the scalp, complete blood count and chemistry panel results were unremarkable, and imaging revealed an intact aneurysm clip. Given the severe unilateral throbbing pain with associated nausea, he was treated with a variety of migraine abortives and other pain medications without significant relief. ESP block was performed. He tolerated the procedure well without complications. His pain decreased to 2/10 from a baseline of 9 to 10/10 30 minutes after the procedure, and he was pain free the next day. Follow‐up revealed a return of his pain 1 to 2 weeks after the procedure, which prompted follow‐up with an outpatient pain management specialist. Conclusion PNBs, ESP block in our case, can be a useful modality in managing chronic neuralgiform pain for treatment‐refractory patients. It can provide improvement in quality of life and spare the patient from medication side effects. In an inpatient setting, it can decrease length of stay that would otherwise be extended due to a trial of multiple medications until the pain was controlled. PNBs are used for a wide spectrum of headache and facial pain disorders. This case report highlights successful management of chronic neuralgiform pain with the ESP block, which has recently been reported to successfully treat headache. ESP block provided relief to the patient's neuralgiform pain that was refractory to multiple medications, resulting in decreased length of stay, fewer medication side effects, and improved quality of life. It also provided a window for initiation of long‐term pain medications.

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Section: Discussionmentioning

confidence: 99%

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

2020

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“…A systematic review, however, did not support these studies [20]. And femoral and sciatic nerve block promoted shorter hospital staying and superior postoperative pain control up to 12 h compared to femoral block plus local infiltration, even though local infiltration could preserve quadriceps function in the immediate postoperative period as an advantage [23–25]. …”

Section: Discussionmentioning

confidence: 99%

Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial

et al. 2017

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BackgroundKnee arthroplasty leads to postoperative pain. This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block.MethodsA randomized non-blinded clinical trial enrolled patients aged over 18 years old, ASA I to III who underwent total knee arthroplasty. All patients underwent spinal anesthesia with isobaric bupivacaine, 20 mg. One group received 100 mcg of intrathecal morphine (M group), and the other received a femoral nerve block by continuous infusion plus a "single shot" block of the sciatic nerve at the end of the surgery (FI group). Pain score from verbal numeric rating scale (VNRS) and morphine consumption during the first 72 h, as well as motor blockade, adverse effects, and postoperative bleeding were recorded. Analysis of variance of repeated measures with Bonferroni post-test, t-test and Fisher exact test were used for statistical analysis.ResultsThirty nine patients completed the study (M = 20; FI = 19 patients) and were similar except for higher age in the FI group. Motor blockade as well as movement pain during postanesthesia care unit (PACU) staying were not different between the groups, but movement pain was significantly lower in FI group after 24 h. Postoperative bleeding (ml) was lower in FI group.ConclusionsContinuous femoral nerve block combined with sciatic nerve block provides effective for postoperative analgesia in patients undergoing total knee arthroplasty, with lower pain scores after 24 h and a lower incidence of adverse effects and bleeding compared to intrathecal morphine.Trial registrationRetrospectively registered on https://clinicaltrials.gov/ under identifier NCT02882152, 23rd December, 2016.

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“…Prolonged length of stay (LOS) has been associated with increased rates of nosocomial infections, medical complications, and poorer surgical and patient-reported outcomes (PROMs) [1][2][3]. Factors that impact LOS in elective orthopedics have been identified, including patient factors (eg, BMI, smoking, age, sex, comorbidities, social support) [4][5][6][7][8], procedure factors (eg, surgeon experience, drain use, use of blocks or local anesthetic infiltration) [9][10][11][12], postprocedural protocols (eg, early mobilization) [6], and hospital factors (eg, volume, orthopedics-specialized ward) [13,14].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Room-Sharing on Length of Stay After Total Hip or Knee Arthroplasty: A Retrospective Study

et al. 2021

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Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block

Abstract: Carvalho Jr. lh et al. 40rev assoC Med bras 2015; 61(1):40-43

Cited by 10 publications

References 32 publications

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial

The Impact of Room-Sharing on Length of Stay After Total Hip or Knee Arthroplasty: A Retrospective Study

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