Reducing costly falls after total knee arthroplasty

Abstract

AIMTo investigate whether adductor canal nerve block (ACB) reduces patient falls when compared to femoral nerve block (FNB) after total knee arthroplasty (TKA).METHODSWe conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease.RESULTSA total of 834 patients had TKA with femoral nerve block and knee immobilizer (FNB + KI). Of those patients, 11 (1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one (0.13%) patient fall was recorded within this group. We used the Fisher’s exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance (P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.CONCLUSIONGiven the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

“…These two reports suggest the limitations in fall prevention program with FNB continuous infusion. Bolarinwa et al reported a fall rate of 0.13% (1 of 791 cases) with ACB compared to 1.3% (11 in 834 cases) with FNB and recommended ACB as the preferred regional analgesia for the TKA procedure [56]. However, it is noteworthy that all falls, even still in the case with ACB, had occurred by POD 2, despite in the fall prevention awareness program [56].…”

“…Bolarinwa et al reported a fall rate of 0.13% (1 of 791 cases) with ACB compared to 1.3% (11 in 834 cases) with FNB and recommended ACB as the preferred regional analgesia for the TKA procedure [56]. However, it is noteworthy that all falls, even still in the case with ACB, had occurred by POD 2, despite in the fall prevention awareness program [56]. In our smaller study, the fall rate was 0% in both groups, despite the older patient population than others, without the knee immobilizer, our strict criteria for initiation of parallel bar gait training could prevent falls.…”

“…Reports on the incidence of falls in FNB and ACB have been inconsistent, some due to differences in postoperative activity restriction [15,27,29,39,42,[54][55][56]. Some studies have investigated the risk of postoperative falling, knee buckling/near falls or imbalance [15,27,42], and their outcomes are referred for the fall prevention practices [15,27,42].…”

Adductor canal block versus femoral nerve block for pain control after total knee arthroplasty: A systematic review and Meta-analysis

“…For more details and answers to all assessment questions in each study, see Supplementary table 2, http://links.lww.com/MD/H2. www.md-journal.com [39] ACB 30 ----FNB 29 ----Brennan et al 2018 [40] ACB [41] ACB 791 ----FNB 834 ----Ardon et al 2015 [42] ACB The pooled studies were heterogeneous (P = .0003, I² = 88%). MMT: Pooled results showed that the ACB group has higher values of muscle strength (MD = 0.73, 95% CI [0.43, 1.02], P < .00001) (Fig.…”

“…2), All the included randomized controlled trials showed moderate to high quality. Eleven cohort studies [24,25,27,28,[34][35][36][37][38]40,41] were fair in quality according to NIH (national institute of health) quality assessment tool for Observational Cohort. One study [42] had good quality.…”