Total Knee Arthroplasty as an Overnight-Stay Procedure Using Continuous Femoral Nerve Blocks at Home: A Prospective Feasibility Study

Abstract

The average duration of hospitalization after total knee arthroplasty (TKA) in the United States is 4-5 days. In this two-phase study we investigated the feasibility of converting TKA into an overnight-stay procedure using a continuous femoral nerve block provided at home through postoperative day 4. Nine of 10 patients met discharge criteria and were discharged home the day after surgery. Pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.

Subacute pain and function after fast‐track hip and knee arthroplasty

“…The horizontal line indicates median, the box indicates IQR, the whiskers indicates the 10th-90th percentiles and the blank circles indicate outliers; pre-op., pre-operative. The choice of early postoperative analgesic technique after lower extremity joint replacement may include continuous peripheral nerve blocks continued after discharge from hospital [3,10,11], while the use of continuous epidural analgesia is not recommended due to a higher risk of side effects [3]. Another option, awaiting future trials, could be the use of local infiltration analgesia [7] with continuous wound infusion of local anaesthetics after discharge.…”

Hospitalization Costs of Total Knee Arthroplasty With a Continuous Femoral Nerve Block Provided Only in the Hospital Versus on an Ambulatory Basis: A Retrospective, Case-Control, Cost-Minimization Analysis

“…17 In a recent prospective longitudinal cohort study, conventional TKA (nonminimally invasive) was performed as an overnightstay procedure in 9 of 10 selected patients by using small, portable infusion pumps that allowed discharge directly home with the CFNB in situ for over 4 postoperative days (PODs). 18 All of these patients reported analgesia equal or superior to patients with hospital-based CFNB. [13][14][15]19 without any associated complications.…”

“…18 Of note, these subjects were a unique subset of patients in that they were all under 70 years of age, had no known cardiac disease or risk factors for deep vein thrombosis, and were interested in returning home the day after a TKA. 18 All other remaining patients who had received a hospital-based CFNB were designated as "controls." Care and resource use for each of the treatment groups was similar except for the earlier discharge in the CFNB group (Table 1).…”

Progressive artificial endocrine pancreas: The era of novel perioperative blood glucose control for surgery

“…Recently, enhanced recovery after surgery (ERAS) or "fast-track surgery" programs have been implemented in an attempt to modify the psychological and metabolic stressors of major surgery. 30 A consequent reduction in postoperative complications and hospital stays associated with colorectal surgery, 31-38 urological, 39,40 and orthopedic [41][42][43][44][45][46][47][48] procedures was reported. Various interventional components are required to facilitate postoperative recovery.…”