Use of peripheral nerve blocks associated with improved joint replacement outcomes
A study by Dr. Memtsoudis and colleagues found that the use of a peripheral nerve block (PNB) was associated with fewer complications following hip and knee replacement surgery.
Credit: Hospital for Special Surgery
Researchers compiled data on more than one million joint replacement patients who received a PNB in addition to general anaesthesia or epidural anaesthesia. Those who received the nerve block had fewer complications after surgery.
The role of anaesthesia techniques and resulting outcomes among the millions of patients undergoing orthopaedic surgery have recently gained widespread interest on a public health care level, according to Stavros G. Memtsoudis, lead investigator. “Previously, a number of studies have shown superior outcomes in patients receiving spinal or epidural regional anaesthesia compared to general anaesthesia,” he said. “In our study, we set out to determine the impact of peripheral nerve blocks (PNBs) — another mode of regional anaesthesia — on outcomes and complications.”
A peripheral nerve block entails the injection of an anaesthetic near a specific nerve or bundle of nerves to block sensations of pain from a specific area. Peripheral nerve blocks have previously been found to improve pain control after joint replacement, but this is the first large study to determine the impact of PNBs on outcomes, according to Memtsoudis, an attending anaesthetist and senior scientist at HSS.
For their study, researchers conducted a retrospective review of more than one million hip and knee replacements performed between 2006 and 2013 using data collected by Premier Perspective. The database contains information from approximately 3,000 hospitals in the United States.
Investigators compiled information on complications, including cardiac, pulmonary, gastrointestinal and renal. They also determined the rate of infections, wound complications, and inpatient falls. In addition, they collected data on “resource utilization,” which included the number of blood transfusions needed, admission to an intensive care unit, opioid consumption, length of hospital stay, and the cost of hospitalisation.
In the study, 342,726 patients had a hip replacement and 719,426 had knee replacement s