Preoperative Nerve Block Research Articles

Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction.

Purpose:We have shown previously that a preoperative paravertebral nerve block is associated with improved postoperative recovery in microvascular breast reconstruction. The purpose of this study was to compare the outcomes of a complete enhanced recovery after surgery (ERAS) protocol with complete regional anesthesia coverage to our traditional care with paravertebral block.Patients and methods:This was a retrospective cohort study of 83 patients who underwent autologous breast reconstruction by T.M.M. between May 2014 and February 2018 at a tertiary academic center. Patients in the ERAS group were additionally administered acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, a transversus abdominis plane block (liposomal or plain bupivacaine), and primarily oral opioids postoperatively. The patients were mobilized earlier with more rapid diet progression. All patients received a preoperative paravertebral block.Results:Forty-four patients in the ERAS cohort were compared with 39 retrospective controls. The 2 groups were similar with respect to demographics and comorbidities. The ERAS cohort required significantly less opioids (291 vs 707 mg oral morphine equivalent, P < .0001) with unchanged postoperative pain scores and a shorter time to oral only opioid use (16.0 vs 78.2 hours, P < .0001). Median length of stay (3.20 vs 4.62, P < .0001) and time to independent ambulation (1.86 vs 2.88, P < .0001) were also significantly decreased in the ERAS cohort. Liposomal bupivacaine use did not significantly affect the results (P ⩾ .2).Conclusions:Implementation of a robust enhanced recovery protocol with complete regional anesthesia coverage was associated with significantly decreased opioid use despite unchanged pain scores, with improved markers of recovery including length of stay, time to oral only narcotics, and time to independent ambulation.

Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study

Background and objectivesMusic medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare...

The Impact of a Preoperative Nerve Block in Foot and Ankle Surgery on the Consumption of Sevoflurane

The Impact of a Preoperative Nerve Block in Foot and Ankle Surgery on the Consumption of Sevoflurane

The Impact of a Preoperative Nerve Block on the Consumption of Sevoflurane in Total Shoulder Arthroplasty

The Impact of a Preoperative Nerve Block on the Consumption of Sevoflurane in Total Shoulder Arthroplasty

Preoperative Pectoral Nerve Block for Acute and Chronic Post-Operative Pain Following Mastectomy

Preoperative Pectoral Nerve Block for Acute and Chronic Post-Operative Pain Following Mastectomy

Do Relaxation Exercises Decrease Postoperative Pain after Rotator Cuff Repair? A Randomized Controlled Trial

Objectives: During the last decade, concern about opioid dependence and abuse has spurred an increasing interest within orthopedic surgery to decrease reliance on narcotics for pain management. Non-pharmacologic interventions, such as patient opioid education, can decrease narcotic consumption after arthroscopic rotator cuff repair (ARCR). Another non-pharmacologic intervention, the use of relaxation exercises, has been promoted for pain management following surgical procedures; however, its’ effect has not been investigated following ARCR. The purpose of this investigation was to evaluate the effects of relaxation exercises on post-operative pain and narcotics use after ARCR. Methods: This was a prospective, randomized, controlled trial evaluating 151 consecutive patients undergoing ARCR. The treatment group (n: 75) received and reviewed relaxation education materials including a 5 minute video explaining relaxation breathing techniques, while the control group (n: 75) received no relaxation education materials. Both groups received a standardized pre-operative interscalene nerve block as well as the same standardized post-op care, including oxycodone 5mg/acetaminophen 325 mg, and cryotherapy. Patients recorded a 5-day journal of their pain level and opioid consumption. Patients were then queried with the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Single Assessment Numerical Evaluation (SANE) score, and Visual Analog Score (VAS) for pain pre-operatively, and at 2, 6, 12, 18, and 24 weeks post-operatively. Additionally, patients were given a follow-up survey at 2 weeks post-operative to assess subjective pain relief efficacy of the relaxation techniques. T-test analyses were utilized to compare differences between the treatment group and the control group. Results: Ninety-five percent of patients completed the follow-up survey. Sixty-three percent (43/68) of study group patients reported that the relaxation techniques decreased their pain levels, while 37% said that it had no effect on their pain. There were no significant differences between the study and control groups in mean post-op VAS pain scores on post-op day 1 (treatment: 55.40, control: 59.5; p= 0.94), post-op day 2 (treatment: 56.15, control: 56.93; p= 0.88), post-op day 3 (treatment: 48.38, control: 47.07; p= 0.52), post-op day 4 (treatment: 40.03, control: 45.54; p= 0.79) and post-op day 5 (treatment: 38.57, control: 40.57; p= 0.71). At two weeks post-op the study group consumed significantly less narcotics than the control group (mean: 21.7 doses vs. 29.7; p= 0.016, Cohen’s d: 0.42), and 51% were still performing the relaxation techniques. There were no significant differences in ASES and SANE scores at each time point throughout the study period. Conclusion: Although nearly two-thirds of patients in the treatment group believed that the use of relaxation breathing techniques decreased their pain, there was no difference in pain measures between the treatment group and the control group. However, the treatment group did utilize less opioid medication than the control group. While the effect on post-op pain is uncertain, the use of relaxation techniques can provide an easy to implement, non-pharmacologic strategy to significantly decrease narcotics consumption after ARCR.

The role of ultrasound-guided single-shot femoral and sciatic nerve blocks on pain management after total knee arthroplasty

BackgroundPeripheral nerve blocks reduce postoperative pain and opioid consumption after total knee arthroplasty (TKA). The aim of this study was to evaluate the effects of single-shot femoral nerve and sciatic nerve blocks on postoperative pain management and opioid consumption after TKA. MethodsThis study included 100 patients who underwent TKA between July 2015 and September 2017. Fifty patients received pre-operative, single-injection, ultrasound-guided femoral and sciatic nerve blocks (Group 1) and 50 did not (Group 2). Multimodal analgesia was otherwise identical, and oxycodone was administered either intravenously or orally if the patients complained of postoperative pain ≥6 on the visual analog scale (VAS). Postoperative VAS scores, opioid consumption, and the fear of future TKA were compared between the groups. ResultsThe mean VAS in the first 18 postoperative hours was significantly lower in Group 1 (P ≤ 0.002). The mean amount of oxycodone taken in the first three postoperative days was significantly lower in Group 1 (P = 0.001). Patient fear of future TKA at 14 days postoperatively was significantly lower in Group 1 (P = 0.027). ConclusionsPre-operative ultrasound-guided, single-shot femoral and sciatic nerve blocks afforded effective pain control in the first 18 h after TKA, and significantly reduced oxycodone consumption in the first three postoperative days.

Two different placement paths in popliteal fossa with a novel nerve block needle for postoperative analgesia after foot and ankle surgery.

Previous studies have documented that single injection nearby the sciatic nerve bifurcation would influence the anesthesia and analgesia effect. But this is uncertain for preoperative continuous popliteal sciatic nerve block. This trial was conducted to compare two paths (proximal to the bifurcation and at the bifurcation) of ultrasound-guided continuous popliteal sciatic nerve block in foot and ankle surgery. Forty recruited objects were randomly assigned to receive ultrasound-guided continuous popliteal sciatic nerve block at the puncture path proximal to the nerve bifurcation either at the nerve bifurcation. Subjects received an injection using a novel nerve block needle with external indwelling cannula guided by ultrasound invented by the corresponding author. The external indwelling cannula was inserted for postoperative analgesia. The primary outcome was NRS scores (at rest and during movement) times at 24 hours after surgery. The secondary outcomes included the measurements related to the performance of the nerve block and efficacy of analgesia, such as anesthesia effect grade, grade of nausea and vomiting, case number of patients with cannula leaking, occlusion or slipping, patient satisfaction, etc. RESULTS: During the surgery, six subjects in the proximal group needed additional analgesic, significantly different from one in the at bifurcation group (P<0.05). There was significant difference on anesthesia effect rating, 1.6±0.8 in the proximal group and 1.1±0.4 in another (P<0.05). The proximal group got 2.1±1.6 of NRS on rest at 24 hours and 1.7±1.5 at 48 hours, and the at bifurcation group got 0.9±1.4 at 24 hours and 0.7±1.1 at 48 hours (P<0.05). The proximal group got more PCA times during 6-24 hours and 24-48 hours and lower satisfaction scores. Continuous popliteal sciatic nerve block at nerve bifurcation could receive better analgesia effect and more patients' satisfaction, rather than proximal to the bifurcation.

Comparison of Postoperative Pain Control Methods after Bony Surgery of the Foot and Ankle

Category: Ankle, Pain Introduction/Purpose: We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery of the foot and ankle. Methods: Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound- guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25 mg) was applied in group A (30 patients), diluted anesthetic (0.2% ropivacaine, 30 ml) was injected into the sciatic nerve once, about 12 hours after the pre-operative nerve block in group B (27 patients), and periodic analgesic intramuscular injection (ketorolac (Tarasyn? R), 30 mg) was performed in group C (27 patients). Visual analog scale (VAS) pain scores at 6, 12, 18, 24, and 48 hours after surgery were checked, and complications of all methods were surveyed. Results: The mean VAS pain score was lower in group B, with a statistically significantly difference (p &lt; .05) between groups A, B, and C at 12 and 18 hours after surgery. Four patients in group A suffered from nausea and vomiting, whereas no other patients complained of any complications or side effects. Conclusion: The ultrasound-guided injection of diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase following foot and ankle bone surgery. By injecting the diluted anesthetic once on the evening of the day of surgery, patients suffered less postoperative pain.

The Effect of Intra-articular Cocktail Versus Femoral Nerve Block for Patients Undergoing Hip Arthroscopy

To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery. An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Demographic data, perioperative pain scores, narcotic consumption, incidence of falls, and iatrogenic peripheral neuritis were collected for analysis. Postoperative data were then collected at routine clinical visits. A total of 193 patients were included in this study (65 males, 125 females). Of them, 105 patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular "cocktail." There were no significant differences in patient demographics, history of chronic pain (P= .35), worker's compensation (P= .24), preoperative pain scores (P= .69), or intraoperative doses of narcotics (P= .40). Patients who received preoperative femoral nerve blocks reported decreased pain during their time in PACU (P= .0001) and on hospital discharge (P= .28); however, there were no statistically significant differences in patient-reported pain scores at postoperative weeks 1 (P= .34), 3 (P= .64), and 6 (P= .70). Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P= .009) and iatrogenic peripheral neuritis (P= .0001). Preoperative femoral nerve blocks are associated with decreased immediate postoperative pain, whereas intraoperative intra-articular anesthetic injections provide effective postoperative pain control in patients undergoing arthroscopic hip surgery and result in a significant reduction in the rate of postoperative falls and iatrogenic peripheral neuritis. Level III, retrospective comparative study.

Intra-articular “Cocktail” Offers Clinical Advantages over Femoral Nerve Block for Postoperative Analgesia in Patients Undergoing Arthroscopic Hip Surgery

Objectives:Arthroscopic hip surgery has gained considerable popularity over the past several years. Attempts to optimize peri and postoperative pain control continues to represent a challenge and opportunity for clinical improvement. Multiple regional anesthesia strategies have been utilized by arthroscopic hip surgeons, including lumbar plexus and femoral nerve blockade, however these options can be associated with setbacks including technical difficulty, intravascular injection, increased post-operative fall risk and the development of peripheral neuritis. Therefore, exploration of alternative regional anesthesia strategies holds promise for improved clinical outcomes. This study aims to explore the efficacy and complication rate of intra-articular anesthetic administration in patients undergoing arthroscopic hip surgery.Methods:A retrospective analysis of prospectively collected data was conducted to identify all patients undergoing elective arthroscopic hip surgery between November 2013 and April 2015. Subjects were stratified into either a group that had received a preoperative femoral nerve block for perioperative pain control or a group that had an intra-articular injection of local anesthetic administered by the surgical team intraoperatively. Objective data, including pre and post-op pain scores in the PACU, total dose of narcotics required perioperatively, occurrence of falls and development of peripheral neuropathy were collected for analysis. Data was compared between the two groups using linear and logistic regression modeling. Statistical significance was determined as p<0.05.Results:After excluding patients who did not meet the criteria for study participation, a total of 193 patients were included in this study. At the time of surgery, one hundred eighty three patients (95%) demonstrated evidence of labralchondral pathology and bony morphology characteristic of femoroacetabular impingement (FAI). One hundred five patients (54%) received a pre-operative femoral nerve block and 88 patients (46%) received an intra-operative intra-articular injection of anesthetic agents. Linear models for post-operative pain, controlled for patient age and pre-operative pain levels, revealed that patients receiving pre-operative femoral nerve blocks had significantly less pain at discharge (p<0.05). There was no statistically significant difference in pain scores between patients receiving pre-operative femoral nerve blocks and those receiving intra-articular injections at post-operative weeks 1, 3 and 6. Patients receiving pre-operative femoral nerve blocks were found to be 3.6 times more likely to experience a post-operative fall (OR 3.58, p < 0.05) and were 14 times more likely to experience post-operative neuropathy (OR 13.99, p < 0.01) than patients receiving an intra-articular injection.Conclusion:Intra-articular anesthetic administration was found to be similar in efficacy to pre-operative femoral nerve blocks at reducing post-operative pain in patients undergoing hip arthroscopy. Additionally, patients receiving intra-articular injections had a significantly decreased risk of falling post-operatively or developing peripheral neuritis, known complications of femoral nerve blocks. With this information, intra-articular anesthetic administration appears to be a safe alternative to femoral nerve blocks in patients undergoing hip arthroscopy.Table 1 Demographic Data Group 1: FemBlock (n=105)Group 2: IABlock (n=88)P valueSex, n Male38270.42 Female6761 Age, mean ± SD, y33.4 ± 13.0231.3 ± 14.050.29Smoking history, n 0.66 Yes2826 No7762 Workers Compensation, n 0.24 Yes41 No10167 History of Chronic Pain, n 0.35 Yes46 No10182 Table 2 Outcomes Group 1: FemBlock (n=105)Group 2: IA Block(n=88)P ValuePreoperative Preoperative pain, mean ± SD3.54 ± 2.693.69 ± 2.430.69Intraoperative Total Dose of Dilaudid, mean ± SD, mg0.18 ± 0.330.22 ± 0.370.40Postoperative Pain on PACU Arrival4.59 ± 2.856.16 ± 2.56<0.01* Pain at Discharge3.55 ± 2.264.28 ± 3.130.03* Pain at 1 week3.05 ± 2.182.75 ± 2.160.34 Pain at 3 weeks1.96 ± 2.131.82 ± 2.070.64 Pain at 6 weeks1.70 ± 2.091.59 ± 1.950.7 Reported a fall, n195<0.01* Developed Peripheral Neuritis, n262<0.01*

Comparison of postoperative pain control methods after bony surgery in the foot and ankle

BackgroundWe performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery in the foot and ankle. MethodsAmong the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound-guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25mg) was applied in group A (30 patients). Diluted anesthetic (0.2% ropivacaine, 30ml) was injected into the sciatic nerve once, about 12h after the preoperative nerve block, in group B (27 patients). Periodic intramuscular injection of an analgesic (ketorolac [Tarasyn], 30mg) was performed in group C (27 patients). The visual analogue scale (VAS) pain scores at 6, 12, 18, 24, and 48h after surgery were checked, and the complications of all methods were monitored. ResultsThe mean VAS pain score was lower in group B, with a statistically significant difference (P<.05) between groups A, B, and C at 12 and 18h after surgery. Four patients in group A experienced nausea and vomiting; however, no other patients complained of any complications or adverse effects. ConclusionThe ultrasound-guided injection of a diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase after bone surgery in the foot and ankle. The injection of the diluted anesthetic once on the evening of the day of surgery resulted in less postoperative pain in the patients. Level of evidenceII.

Combined Sciatic and Lumbar Plexus Nerve Blocks for the Analgesic Management of Hip Arthroscopy Procedures: A Retrospective Review

ABSTRACTHip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

Effect of Topically Applied Anaesthetic Formulation on the Sensitivity of Scoop Dehorning Wounds in Calves.

The post-operative effects of three formulations of topical anaesthetic and a cornual nerve block on the sensitivity of scoop dehorning wounds in calves were compared in two trials. In Trial 1, 21 female Holstein dairy calves aged 8 to 24 weeks were randomly allocated to two groups: (1) scoop dehorning with a post-operative application of a novel topical anaesthetic powder (DTAP, n = 10); and (2) scoop dehorning with a post-operative application of a novel topical anaesthetic ethanol liquid (DTAE, n = 11). In Trial 2, 18 castrated male and 18 female Hereford beef calves aged 16 to 20 weeks were randomly allocated to four groups: (1) scoop dehorning with a pre-operative cornual nerve block of lignocaine (DCB, n = 9); (2) scoop dehorning with a post-operative application of the novel topical anaesthetic ethanol liquid from Trial 1 (DTAE, n = 9); (3) scoop dehorning with a post-operative application of a topical anaesthetic gel (DTAG, n = 9); and (4) sham dehorning (CON, n = 9). Sensitivity was assessed by scoring the behavioural response of calves to stimulation of the wound or skin at time points before and after treatment. In Trial 1, DTAP calves had a greater probability of displaying more severe responses than DTAE calves at 90 and 180 min (P < 0.001). In Trial 2, at 1 h, DTAG calves had a greater probability of displaying more severe responses than CON calves. At 2 h onwards, all dehorned calves had a greater probability of displaying more severe responses than CON calves (P < 0.001). There were no differences between the responses of DCB, DTAG and DTAE calves at any time point. Topical anaesthetic formulations result in almost immediate but temporary anaesthesia of the wound following scoop dehorning in calves and may provide a practical option for pain relief on-farm.

Partial Radial Nerve Transfers for Patients with Isolated Traumatic Axillary Nerve Injuries: Level 4 Evidence

There is no financial information to disclose. Isolated axillary nerve injuries can occur subsequent to trauma or as a direct complication from shoulder procedures. While partial radial to axillary nerve transfers have previously been described, there has been a lack of information related to patient selection, surgical methodology, and outcomes. We hypothesize that partial radial to axillary nerve transfers is an under-utilized, promising treatment option for patients with this devastating injury. We performed a retrospective analysis of all partial radial nerve transfers for isolated axillary nerve injuries (n = 7) performed by a single surgeon at 1 institution over the past 4 years. All patients had nerve conduction studies verifying a complete axillary nerve lesion with no reinnervation as detailed by fibrillation potentials without evidence of nascent potentials. The surgery consisted of (1) using a direct posterior approach to the arm, (2) isolating one fascicle of the radial nerve responsible for only elbow flexion as confirmed by intra-operative monitoring, and (3) coapting this branch to the proximal portion of the axillary nerve in the quadrilateral space. All patients were protected in a shoulder sling for 3 weeks until the nerve repair healed. There was no donor nerve deficit for any patient. Four of the 7 patients had undergone previous shoulder surgery and had received a preoperative nerve block. One patient had the nerve transfer performed within 4 months of injury and regained functional motion with forward elevation to 160 degrees and M4 strength. The other patients had surgery after the initial 7 months after the injury and did not have any meaningful improvement in function after the nerve transfer. The other 3 patients had an axillary nerve injury related to a traumatic injury and had nerve transfer performed within the initial 6 month time period. One patient has subsequent restoration of his deltoid muscle; however, his range of motion was limited due to an underlying proximal humerus nonunion. The other 2 patients have forward elevation to 160 degrees with M4 strength. •For patients with axillary nerve injuries, a partial radial to axillary nerve transfer is a safe procedure without donor deficit that can provide functional recovery with early intervention.•While the expanded use of regional anesthesia may cloud the initial post operative exam for patients undergoing shoulder surgery, the surgeon should be suspicious of patients who do not demonstrate recovery and refer patients early for intervention rather than prolonged observation in order to maximize the chances of recovery.

Effect of Preoperative Nerve Block on Postthyroidectomy Headache and Cervical Pain: A Randomized Prospective Study

The aim of the current study was to investigate the efficacy of greater occipital nerve (GON) block and bilateral superficial cervical plexuses (BSCP) blocks in alleviating postoperative occipital headache and posterior neck pain after thyroidectomy. This randomized prospective study consisted of 75 women undergoing total thyroidectomy. Patients were randomized into three groups: Group I (n = 25): patients receiving GON, Group II (n = 25): patients receiving bilateral (BSCP) blocks, and Group III (n = 25): patients receiving no block. Assessment of occipital headache, posterior neck, and incision site pains was made at 12 hours and 24 hours after extubation by Visual Analogue Scale (VAS). In comparison to Group III significantly fewer patients in Groups I and II experienced occipital headache at 12 (p = 0.006) and 24 hours (p = 0.005) and also posterior neck pain at 24 hours (p = 0.003). Mean VAS scores at 12 and 24 hours for occipital headache (p = 0.003 and p = 0.041) and posterior neck pain (p = 0.015 and p = 0.008) were significantly lower in Group I. The differences between Groups II and III were not significant except for the occipital headache at 12 hours. The efficacy of GON block is superior to BSCP blocks in alleviating postthyroidectomy occipital headache and posterior cervical pain.

Pain Management Discussion Forum: Prevention of Chronic Postoperative Pain

ABSTRACTA case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described.This report is adapted from paineurope 2014; Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

Preoperative Sciatic and Femoral Nerve Blocks for Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis

Objective: Uncontrolled postoperative pain and nausea and vomiting are the most common causes for hospital admission following ambulatory anterior cruciate ligament (ACL) reconstruction. Therefore, finding techniques that provide excellent postoperative pain control is of critical importance. This retrospective study compared patients who received preoperative femoral nerve blockade to those who received combined femoral and sciatic nerve blockade. We hypothesized that a combined preoperative nerve block would result in lower postoperative pain, decreased postoperative opioid consumption, and shorter recovery. Methods: The medical records of 191 patients who underwent ACL reconstruction were retrospectively analyzed. We then developed multivariable regression models for each primary outcome parameter. Results: The postoperative pain scores were lower in patients receiving a combined nerve block compared with patients receiving a femoral nerve block (P<0.001) and higher in patients receiving an autograft vs. an allograft (P=0.009). Total morphine equivalents were lower in patients receiving combined nerve block versus patients receiving femoral nerve block (P<0.001) and higher in patients with a higher BMI (P<0.001). Recovery unit length of stay was prolonged by more than 25 minutes in patients with PONV (P=0.001) and in patients who needed a postoperative nerve block in the recovery unit (P ≤ 0.001). Conclusions: A preoperative combined sciatic and femoral nerve block improved postoperative pain management, while postoperative nausea and vomiting or the need for a postoperative nerve block increased the recovery unit time.

Day of Surgery Discharge after Unicompartmental Knee Arthroplasty: An Effective Perioperative Pathway

Day of surgery (DOS) discharge after unicompartmental knee arthroplasty (UKA) allows for safe, efficient care of the appropriately selected patient. Refinement of our perioperative pathway over the last decade has allowed for successful DOS discharge of 160 consecutive patients. The cohort averaged 65 years and American Society of Anesthesiology class was 1-3 (mean, 1.8). Perioperative pain control included a preoperative single shot femoral nerve block. Mean recovery room time was 121 (SD = 37) minutes. No patient required overnight admission for uncontrolled pain or nausea. Significant improvements in Knee Society Clinical Rating System (KSCRS) scores and high patient satisfaction were observed. This study details critical components of our simple perioperative pathway that can be utilized to safely perform UKA with discharge on the DOS.

Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release

Intravenous regional anesthesia (Bier block) is indicated for minor procedures such as carpal tunnel release but must be performed in the operating room. We hypothesize that preoperative peripheral nerve blocks decrease anesthesia-controlled time compared to Bier block for carpal tunnel release. With IRB approval, we reviewed surgical case data from a tertiary care university hospital outpatient surgery center for 1 year. Unilateral carpal tunnel release cases were grouped by anesthetic technique: (1) preoperative nerve blocks, or (2) Bier block. The primary outcome was anesthesia-controlled time (minutes). Secondary outcomes included surgical time and time for nerve block performance in minutes, when applicable. Eighty-nine cases met criteria for analysis (40 nerve block and 49 Bier block). Anesthesia-controlled time [median (10th-90th percentiles)] was shorter for the nerve block group compared to Bier block [11 (6-18) vs. 13 (9-20) min, respectively; p = 0.02). Surgical time was also shorter for the nerve block group vs. the Bier block group [13 (8-21) and 17 (10-29) min, respectively; p < 0.01), but nerve blocks took 10 (5-28) min to perform. Ultrasound-guided nerve blocks performed preoperatively reduce anesthesia-controlled time compared to Bier block and may be a useful anesthetic modality in some practice environments.