Retrospective Analysis of Pain After Nerve Block in Surgical Patients

Study Overview
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Brief Summary
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This is a retrospective study looking at patients who received a nerve block for surgery and assessing pain after the nerve block resolves, with or without an educational intervention, over two periods of time.

Detailed Description
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Regional anesthesia (RA) is a vital tool that can serve as the primary anesthetic or as part of a multimodal perioperative pain regimen. RA is strongly associated with decreased acute and persistent pain and opioid consumption postoperatively. However, some patients experience an acute worsening of pain into the severe range around the time of RA resolution, also known as rebound pain (RP). The incidence of RP has been reported as high as 40-50% after a single shot nerve block for patients undergoing ambulatory surgery. This retrospective study aims to look at patients who received a nerve block for surgery and assessing pain after the nerve block resolves in the presence and absence of certain interventions, such as a multidisciplinary educational intervention. The investigators will assess patients who received a primary total knee arthroplasty who received a single shot adductor canal nerve block, received pericapsular injection by the surgeon, and had a length of stay > 16 hours.

Official Title
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Retrospective Analysis of Pain in Patients Who Receive a Nerve Block for Surgery

Conditions
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Acute Pain, Knee Osteoarthritis, Regional Anesthesia Morbidity

Intervention / Treatment
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* Other: Educational intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary total knee arthroplasty received an adductor canal nerve block received pericapsular injection by surgeon intraoperatively admitted for overnight stay and > 16 hours post-nerve block Exclusion Criteria: age < 18 prior total knee arthroplasty on ipsilateral knee
Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| TKA with nerve block no intervention<br>Patients who received a single shot adductor canal nerve block prior to total knee arthroplasty surgery January 2017-December 2017 | |
| TKA with nerve block with intervention<br>Patients who received a single shot adductor canal nerve block prior to total knee arthroplasty surgery during March 2019-March 2020, and received an educational intervention | Other: Educational intervention<br>* Multidisciplinary educational intervention was performed by orthopedic, anesthesia, and nursing team. This included a discussion of the patient's pain plan and a patient visit.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall pain score | Difference in area under the curve of pain scores, numerical pain rating scale 0-10, 8-16 hours after nerve block between the two cohorts (educational intervention and non-educational intervention time periods) | 8-16 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference in maximum pain score post-nerve block | Difference in maximum pain score, numerical pain rating scale 0-10, 8-16 hours after nerve block between the two cohorts | 8-16 hours | 
| Difference in incidence of rebound pain | Difference in incidence pain score ≥ 7 between 8-16 hours post nerve block between the two cohorts | 8-16 hours |