Effects of clinical pathways in the joint replacement: a meta-analysis

Barbieri, A; Vanhaecht, Kris; Herck, Pieter Van; Sermeus, Walter; Faggiano, Fabrizio; Marchisio, S; Panella, Massimiliano

doi:10.1186/1741-7015-7-32

Cited by 234 publications

(191 citation statements)

References 46 publications

(87 reference statements)

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“…Moreover, it is worth noting that this study focused on actual patients undergoing TKA, instead of healthy volunteers, and the comparison of a newer technique to an established standard (i.e., femoral CPNB) [19]. Third, our results occurred within the context of a particular, established clinical pathway and therefore may not generalize well to hospitals practicing without a similar clinical pathway [1]. Fourth, our study comes from a single, university-affiliated VA medical center with factors typical to that practice setting (including a predominantly male patient population and the involvement of residents in patient care) and so may not be generalizable to every institution.…”

Section: Discussionmentioning

confidence: 84%

“…Clinical care pathways for patients undergoing joint arthroplasty have been increasingly incorporating continuous peripheral nerve block (CPNB) techniques for postoperative analgesia [1,8]. Besides offering pain relief, clinical pathways using CPNB have demonstrated a shortened time to functional recovery and decreased postoperative adverse events [8].…”

Section: Introductionmentioning

confidence: 99%

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Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Mudumbai

Kim

Howard

et al. 2014

Clinical Orthopaedics &Amp; Related Research

121

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Background Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. Questions/purposes We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay.Methods Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. Results Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10 Conclusions Adductor canal CPNB may promote greater early postoperative ambulation compared to femoral CPNB after TKA without a reduction in analgesia. Future randomized studies are needed to validate our major findings. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Mudumbai

Kim

Howard

et al. 2014

Clinical Orthopaedics &Amp; Related Research

121

View full text Add to dashboard Cite

show abstract

“…As a consequence, their use is still jeopardized in high volume and costly care like HCC. Evidence is needed to support public health decision makers in their understanding the real impact of this methodology (Panella et al, 2008;Barbieri et al, 2009).…”

Section: Impact Of a Clinical Pathway On Hospital Costs Length Of Stmentioning

confidence: 99%

Impact of a Clinical Pathway on Hospital Costs, Length of Stay and Early Outcomes after Hepatectomy for Hepatocellular Carcinoma

Zhu¹,

Li²,

Li³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…For the observed treatment pathways the rate of inpatient complications was significantly lower and the length of stay shorter compared to the normal care pathway (Barbieri et al 2009).…”

Section: Surgery and Perioperative Managementmentioning

confidence: 93%

“…In a meta-analysis (n = 22 studies), Barbieri et al (2009) investigated the effect of structured treatment pathways for hip and knee joint replacements. For the observed treatment pathways the rate of inpatient complications was significantly lower and the length of stay shorter compared to the normal care pathway (Barbieri et al 2009).…”

Section: Surgery and Perioperative Managementmentioning

confidence: 99%