Reducing costly falls after total knee arthroplasty
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摘要
AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We 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. RESULTS A 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.CONCLUSION Given 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.
AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We 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. RESULTS A 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.CONCLUSION Given 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.
AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We 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. RESULTS A 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.CONCLUSION Given 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.
引文
1 Kurtz S,Ong K,Lau E,Mowat F,Halpern M.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.J Bone Joint Surg Am 2007;89:780-785[PMID:17403800 DOI:10.2106/JBJS.F.00222]
2 Martin GM,Crowley M.Total knee arthroplasty.Available from:URL:https://www.uptodate.com/contents/total-knee-arthroplasty
3 Berger RA,Sanders S,D’Ambrogio E,Buchheit K,Deirmengian C,Paprosky W,Della Valle CJ,Rosenberg AG.Minimally invasive quadriceps-sparing TKA:results of a comprehensive pathway for outpatient TKA.J Knee Surg 2006;19:145-148[PMID:16642894DOI:10.1055/s-0030-1248097]
4 Cui Q,Schapiro LH,Kinney MC,Simon P,Poole A,Novicoff WM.Reducing costly falls of total knee replacement patients.Am J Med Qual 2013;28:335-338[PMID:23322911 DOI:10.1177/1062860612469440]
5 Elkassabany NM,Antosh S,Ahmed M,Nelson C,Israelite C,Badiola I,Cai LF,Williams R,Hughes C,Mariano ER,Liu J.The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block:A Double-Blinded Randomized Controlled Study.Anesth Analg 2016;122:1696-1703[PMID:27007076 DOI:10.1213/ANE.0000000000001237]
6 Li D,Ma GG.Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc 2016;24:2614-2619[PMID:26611901 DOI:10.1007/s00167-015-3874-3]
7 Gao F,Ma J,Sun W,Guo W,Li Z,Wang W.Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty:A Systematic Review and Meta-analysis.Clin J Pain 2017;33:356-368[PMID:27322397 DOI:10.1097/AJP.0000000000000402]
2 Martin GM,Crowley M.Total knee arthroplasty.Available from:URL:https://www.uptodate.com/contents/total-knee-arthroplasty
3 Berger RA,Sanders S,D’Ambrogio E,Buchheit K,Deirmengian C,Paprosky W,Della Valle CJ,Rosenberg AG.Minimally invasive quadriceps-sparing TKA:results of a comprehensive pathway for outpatient TKA.J Knee Surg 2006;19:145-148[PMID:16642894DOI:10.1055/s-0030-1248097]
4 Cui Q,Schapiro LH,Kinney MC,Simon P,Poole A,Novicoff WM.Reducing costly falls of total knee replacement patients.Am J Med Qual 2013;28:335-338[PMID:23322911 DOI:10.1177/1062860612469440]
5 Elkassabany NM,Antosh S,Ahmed M,Nelson C,Israelite C,Badiola I,Cai LF,Williams R,Hughes C,Mariano ER,Liu J.The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block:A Double-Blinded Randomized Controlled Study.Anesth Analg 2016;122:1696-1703[PMID:27007076 DOI:10.1213/ANE.0000000000001237]
6 Li D,Ma GG.Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc 2016;24:2614-2619[PMID:26611901 DOI:10.1007/s00167-015-3874-3]
7 Gao F,Ma J,Sun W,Guo W,Li Z,Wang W.Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty:A Systematic Review and Meta-analysis.Clin J Pain 2017;33:356-368[PMID:27322397 DOI:10.1097/AJP.0000000000000402]