Executive Summary
A Retrospective Chart Review to Compare Two Peripheral Nerve Blocks for Analgesia Following a Total Knee Replacement
Problem: Pain after a total knee replacement (TKR) can be severe. The most commonly used pain management 24 hours after surgery is administration of intravenous opioids, which by itself does not always provide adequate post op pain relief ( Otten, C. & Dunn, K. 2011; Kerr, D. 2008; Jenstrup, M.T et al 2011). With the current opioid crisis, controlling pain without opioids whenever possible is essential.
Purpose: To analyze whether a combination block of an adductor canal block with intra-articular infiltration (AII) or an adductor canal block (ACB) alone can provide enough pain relief that there will be minimal or no need to use opioids for pain relief 24 hours TKR post-surgery.
Goal: To decrease opioid requirement to relieve pain 24 hours post TKR surgery.
Objective: To compare efficacy to reduce opioid requirement 24 hours post TKR surgery between an AII or an ACB alone.
Plan: A quality improvement convenience sample retrospective chart review.
Outcomes and Results: Sixty charts were reviewed, 30 for men and 30 for women and further divided by men and women that received AII or an ACB prior to undergoing TKR surgery block (N=15 men and 15 women for AII and for ACB). There was a significant decrease (p=0.015) in reported pain with the AII block (N=30) than with the ACB block (N= 30). All participants in the AII group had a recording of pain score of 0 compared to six participants in the ACB group with an initial pain score of two and 15 participants in ACB group with an initial pain score of three
