key: cord-1045543-elo1i26a
authors: Pollard, Brian A.; Meschino, Celine; Teja, Bijan; Hare, Gregory M. T.; Jobaneh, Yekta Soleimani; Butler, Chloe; Khan, Ryan; Hall, Jeremy; Daniels, Timothy
title: Continuous peripheral nerve blocks for outpatient orthopedic surgery: improving patient care and hospital efficiency through knowledge translation
date: 2022-04-27
journal: Can J Anaesth
DOI: 10.1007/s12630-022-02245-w
sha: 1d350d8e23ce8d0d59c3b341f7102d3bac80c382
doc_id: 1045543
cord_uid: elo1i26a

nan

Recent clinical approaches in elective orthopedic surgery have focused on minimizing opioid requirements because of the potential risk of adverse effects, diversion of residual prescribed opioids, and long-term opioid dependence. 1 This approach to reduce dependence on opioids, while providing excellent postoperative analgesia, has been greatly supported by increased utilization of regional anesthesia, 2 an approach that may also improve resource utilization. 3 Moreover, avoiding general anesthesia as an aerosol-generating medical procedure may improve healthcare efficiency and overall risk during the COVID-19 pandemic. 4, 5 A recent meta-analysis 2 has shown that a continuous infusion of local anesthetics through a perineural catheter provides excellent analgesia, reduces opioid utilization, and provides high patient satisfaction scores. Therefore, we implemented a continuous peripheral nerve block (CPNB) strategy to improve the overall patient healthcare experience and accessibility to care via an outpatient model while reducing cost and increasing efficiencies in hospital care.

With ethics board approval and patient consent, we initially enrolled 20 patients for shoulder (n = 10) and foot and ankle surgery (n = 10) into a peer-review funded pilot study to determine the feasibility of implementing a daysurgery model of care based on the use of CPNB for primary postoperative analgesia. We supplemented continuous outpatient local anesthetic infusions via perineural catheters with multimodal opioid and nonopioid oral medications perioperatively to facilitate same-day discharge. Data are presented as median [interquartile range (IQR)]. We performed comparisons between pain scores (analysis of variance on ranks with repeated measures) and satisfaction scores (Wilcoxon signed rank test) and assigned statistical significance at P \ 0.05.

Patients presenting for either shoulder or foot and ankle surgery, with median [IQR] baseline preoperative pain scores of 4.8 In summary, the results of our pilot study supported the feasibility to manage shoulder and ankle arthroplasty procedures with continuous peripheral nerve blocks (CPNB) in a day surgery setting. Combined with our subsequent survey, we observed high patient satisfaction, excellent pain relief with pain scores comparable to those preoperatively, modest opioid use, and no serious adverse effects or untoward outcomes. On the basis of these results, we have subsequently expanded to performing between 300 and 700 CPNBs annually (by staff, fellows, and residents), 300 of which are performed in day-surgery patients. The longitudinal review of our outcome data continues to support the effectiveness, safety, and generalizability of this care model with respect to our initial goals. The CPNB catheter program has expanded to facilitate further implementation of a multimodal perioperative approach towards reducing the necessity of general anesthesia and reducing perioperative opioid requirement for upper and lower extremity orthopedic surgeries. This approach has also received peer-reviewed innovation funding to assess ''Narcotic Free Shoulder The data indicate that these elective patients had significant levels of preoperative pain, that implementation of a continuous peripheral nerve block reduced pain levels (shoulder surgery), and that postoperative pain levels were not different from preoperative levels for both types of surgery. In both cases, there was a high degree of patient satisfaction with this approach.

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The efficacy and safety of continuous versus single-injection popliteal sciatic nerve block in outpatient foot and ankle surgery: a systematic review and meta-analysis

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