Date of Degree

5-2015

Document Type

Capstone Project

Degree Name

D.P.T.

Program

Physical Therapy

Advisor

Elaine Rosen

Subject Categories

Physical Therapy

Abstract

PURPOSE: Given the large number of Total Knee Replacements (TKR) performed annually in the US and the prediction that those numbers will increase, providing optimal analgesia during TKR is an important strategy for reducing cost and improving patient outcomes. Currently, no standard analgesia protocol for TKR exists and facilities in the US and world-wide use varied methods of analgesia. The purpose of the present study is to determine which analgesic technique; femoral nerve block (FNB), saphenous nerve block (SNB) or periarticular injection (PAI), within the context of a multi-modal pain management regimen, results in optimal TKR patient outcomes and achievement of functional milestones, as well as decreased length of stay (LOS).

METHODS: A retrospective, non-randomized design was employed using a convenience sample of 1,644 patients undergoing primary, unilateral TKR at HSS. 652 patients were included in the FNB group, 873 patients in the SNB group, and 119 patients in the PAI group. Physical therapists assessing and treating patients post-operatively, documented LOS and achievement of functional milestones, including the ability to transfer, ambulate and perform stairs. The data was analyzed to determine if the various methods of analgesia are associated with improved patient outcomes.

RESULTS: A significant statistical difference in LOS (p

CONCLUSIONS: This study suggests that alternate methods of perioperative anesthesia used in TKR, including SNB and PAI, are associated with improved outcomes over FNB. This review supports further research of both SNB and PAI techniques due to their potential in improving patient functional outcomes, reducing LOS and decreasing costs.

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