Adherence to a Multimodal Analgesic Clinical Pathway: A Within-Group Comparison of Staged Bilateral Knee Arthroplasty Patients. Issue 3 (May 2017)

• Record Type: Journal Article
• Authors: Steckelberg, Rachel C.; Funck, Natasha; Kim, T. Edward; Walters, Tessa L.; Lochbaum, Gregory Milo; Memtsoudis, Stavros G.; Giori, Nicholas J.; Indelli, Pier F.; Graham, Lorrie J.; Mariano, Edward R.
• Is Part Of: Regional anesthesia and pain medicine. Volume 42:Issue 3(2017)
• Publication Date: 2017-05
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1097/AAP.0000000000000588
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and Objectives: Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing staged bilateral procedures. Methods: This study was performed at a hospital with a Perioperative Surgical Home program and knee arthroplasty clinical pathway using multimodal analgesia and adductor canal catheters. Data were examined for all orthopedic surgery patients over a 4-year period. We included patients who had staged bilateral knee arthroplasty electively scheduled on 2 separate dates. The primary outcome was rate of adductor canal catheter utilization as a measure of adherence to the clinical pathway. Other outcomes included rates of neuraxial anesthesia and minor and major perioperative complications. Results: We analyzed data for 103 unique patients. The interval between surgeries was a median of 261 days (10th–90th percentile, 138–534 days). All 103 patients had adductor canal catheters for both the first and second surgeries ( P > 0.999). Forty-one percent of patients had the same surgeon for both surgeries, but only 2% had the same anesthesiologist ( P < 0.001). From the first to the second surgery, utilization of neuraxial anesthesia increased from 51% to 68%, respectively ( P = 0.005). There were no differences in minor or major complications. Conclusions: For staged bilateral knee arthroplasty patients, 100% clinical pathway adherence including perineural catheters and multimodal analgesia is feasible despite multiple variables. We believe that patient-centered acute pain management requires consistent and reliable delivery of care.