Peripheral nerve‐blocks and associations with length of stay and readmissions in fast‐track total hip and knee arthroplasty

Abstract

Background: Peripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain.Methods: An observational multicenter study from January to August 2017 in six Danish Arthroplasty Centers with established fast-track protocols. Prospective recording of preoperative characteristics and information on PNB, LOS and readmissions through the Danish National Patient Registry and medical records. Multiple logistic regression was used to investigate associations between PNB and a LOS >1 day, LOS >4 days, and 30-days readmissions. We also reported on mobilization, pain, opioid and fall-related complications leading to LOS >4 days or readmissions.Results: A total of 2027 (58.6%) THA and 1432 (41.4%) TKAs with a median LOS of 1 day (IQR 1-2) and 5.3% (CI:4.6-6.1) 30-days readmission rate were identified. PNB was used in 40.7% (CI:38.2-43.3) of TKA and 2.7% (CI:2.0-3.5) of THA, but with considerable interdepartmental variation (0.0-89.0% for TKA). There was no associa-

Reply to Dr.'s Zheng, Fan and Zheng: Fascia iliaca compartment block improves the efficacy of analgesic and postoperative rehabilitation

“…5 In contrast, our study in fast-track THA and TKA with a fully implemented multimodal opioid-sparing analgesic regimen, demonstrated that the majority of patients were discharged within 1-2 days regardless of the use of PNB and with no differences in readmissions. 2 Consequently, although our study did not assess the analgesic effect of PNB's per se, our data does not support any added benefit on length of stay or readmissions with routine PNB in fasttrack THA.…”

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comment 1 on our recently published study on the use of peripheral nerveblocks and associations with length of stay and readmissions in fast-track total hip and knee arthroplasty. 2 We agree that the type and technique of peripheral nerveblocks (PNB) is important when evaluating effect on postoperative pain, opioid consumption and hospital stay and readmissions. This was why we, in contrast to most other studies on pain and opioid use, 3 made the effort to provide information on the type of applied nerve blocks and consequences in a full recovery program.

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Fascia iliaca compartment block improves the efficacy of analgesic and postoperative rehabilitation

“…Dear Editor, In a recent study by Jørgensen et al 1 regarding the relationship between peripheral nerve blocks (PNBs) and length of stay and readmissions in total hip and knee arthroplasty (THA and TKA), we read with great interest the research findings. According to the authors, routine use of PNBs, such as femoral nerve block and lateral cutaneous femoral block, was not associated with early discharge or 30-day readmissions in THA.…”

Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review

“…To improve postoperative pain after THA, multimodal-analgesia can be implemented and opioid therapy dosage can be reduced by performing peripheral regional nerve blocks (PNB) [ 74 ]. PNB is recommended in THA as it reduces pain, allows early mobilization, and reduces morphine consumption while decreasing the risk of pain-related complications [ 75 , 76 , 77 , 78 ]. Different techniques can be adopted: femoral nerve block, sciatic nerve block, single shot, or continuous infusion [ 74 ].…”

“…This technique is beneficial for patients who undergo THA because it provides sufficient postoperative analgesia, especially against immediate postoperative resting pain [ 79 , 80 ]. Its relation to LOS is, however, still debated, and therefore, its routine use should be evaluated singularly [ 75 ].…”