![]() The advent of multimodal pain protocols and regional anesthesia has drastically decreased the morbidity and length of hospital stay associated with the procedure. As a result “enhanced recovery” or “fast-track” pathways are being described to help accelerate the patient's discharge without an increase in pain, readmission, or complications. įurthermore, two issues have gained considerable attention in the current literature, discharge destination and opioid consumption. First, post-hospital discharge rehabilitation can account for 36–55% of the total cost for TKA, and these facilities have been associated with severe adverse events and unplanned readmission when controlling for confounding variables. Attempts to facilitate home discharge may be beneficial in not only reducing costs associated with patient care but also more importantly improving patient outcomes. Second, it has been well publicized that the United States (US) is currently in an opioid epidemic, with some placing it on similar magnitude of the acquired immune deficiency syndrome (AIDS) epidemic of the 1980s. As the third leading prescribers of opioids in the US, orthopedic surgeons, in particular, arthroplasty surgeons must find a balance between managing postoperative pain and overprescribing. Adjunct pain modalities to limit the amount of opioid consumption after TKA will be critical in helping patients wean off these medications quickly and avoid dependence. However, the ideal postoperative recovery pathway has not been identified. As new regional anesthetic techniques and injectable medications became available, the protocol at our institution changed with the goal of improving patient outcomes. The purpose of this study was to retrospectively examine a Level 1 academic center's experience with two consecutive postoperative pain protocols after TKA and to investigate their effect on primary outcomes of discharged destination, opioid consumption, and length of stay (LOS). Secondary outcomes of the study were visual analogue scale (VAS), ambulation distance, and complications.Ī retrospective chart review was performed from Jto October 1, 2014. #Ipack block cpt code codeĪll primary, unilateral total knee arthroplasty patients were identified by Current Procedural Terminology (CPT) code 27447. Medicare patients being discharged to a Results Patient variables commonly considered exclusion criteria in previous studies such as prior history of arthroscopy, psychiatric conditions (anxiety and depression), and preoperative opioid use were included, as well as all payer mixes. The study population consisted of 264 consecutive patients comprised of 43.6% male with mean age of 66.2 ± 9.4 years (standard deviation). Analgesic group counts included 146 in the FNB + LB-PAI group and 118 patients in the ACC + iPACK group. The only differences identified at baseline in the univariable analyses were a high ASA score (ASA > 2, 61.0% vs 47.9%, p = 0.034), higher incidence of depression (26.3% vs 15.1%, p = 0.024), and a higher Discussion The two groups were well matched (Table 2).
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