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Continuous peripheral nerve blocks for pain control after orthopaedic surgery
Journal
European Journal of Anaesthesiology Intensive Care
ISSN
2767-7206
Date Issued
2025-01-23
Author(s)
Patricio A. Leyton
Marcia Robles
Javiera Vargas
Loreto A. Muñoz
Type
journal-article
Abstract
<jats:sec>
<jats:title>BACKGROUND</jats:title>
<jats:p>Continuous peripheral nerve blocks (CPNB) provide an opioid-free alternative for pain control after orthopaedic surgery. However, postdischarge ambulatory patient care and follow-up concerns have prevented CPNB use at home.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>OBJECTIVE</jats:title>
<jats:p>To address physicians’ concerns about the outpatient use of CPNB.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>DESIGN</jats:title>
<jats:p>Prospective, cohort, observational study.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>SETTING</jats:title>
<jats:p>Single centre, teaching private hospital in Santiago, Chile, between July 2016 and March 2020.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>PATIENTS</jats:title>
<jats:p>We included patients aged at least 18 who underwent orthopaedic surgery using CPNB for postoperative pain management. Patients scheduled simultaneously for non-orthopedic surgery on the same event were excluded.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>MAIN OUTCOME MEASURES</jats:title>
<jats:p>Pain scores, opioid use, and complication rates at both in-hospital and at-home sites.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>RESULTS</jats:title>
<jats:p>CPNB were provided as an analgesia plan in 497 patients who met inclusion criteria, and 387 (77.87%) were discharged home with this continuous analgesia. At 48 h, 70% of the patients reported no-worse-than-mild pain. Less than 3.1% of patients reported an episode of severe pain, and less than 13% of the patients required opioid rescue medication. Transient neurological symptoms were observed in 13% (95% confidence interval (CI), 10.4 to 16.1) of the patients. No long-term or severe complications were observed. High rates of satisfaction were reached among patients.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>CONCLUSION</jats:title>
<jats:p>In-hospital and at-home use of CPNB supervised by a pain service team provides a feasible and safe alternative after orthopaedic surgery, pain control with a low requirement of opioids.</jats:p>
</jats:sec>
<jats:title>BACKGROUND</jats:title>
<jats:p>Continuous peripheral nerve blocks (CPNB) provide an opioid-free alternative for pain control after orthopaedic surgery. However, postdischarge ambulatory patient care and follow-up concerns have prevented CPNB use at home.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>OBJECTIVE</jats:title>
<jats:p>To address physicians’ concerns about the outpatient use of CPNB.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>DESIGN</jats:title>
<jats:p>Prospective, cohort, observational study.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>SETTING</jats:title>
<jats:p>Single centre, teaching private hospital in Santiago, Chile, between July 2016 and March 2020.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>PATIENTS</jats:title>
<jats:p>We included patients aged at least 18 who underwent orthopaedic surgery using CPNB for postoperative pain management. Patients scheduled simultaneously for non-orthopedic surgery on the same event were excluded.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>MAIN OUTCOME MEASURES</jats:title>
<jats:p>Pain scores, opioid use, and complication rates at both in-hospital and at-home sites.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>RESULTS</jats:title>
<jats:p>CPNB were provided as an analgesia plan in 497 patients who met inclusion criteria, and 387 (77.87%) were discharged home with this continuous analgesia. At 48 h, 70% of the patients reported no-worse-than-mild pain. Less than 3.1% of patients reported an episode of severe pain, and less than 13% of the patients required opioid rescue medication. Transient neurological symptoms were observed in 13% (95% confidence interval (CI), 10.4 to 16.1) of the patients. No long-term or severe complications were observed. High rates of satisfaction were reached among patients.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>CONCLUSION</jats:title>
<jats:p>In-hospital and at-home use of CPNB supervised by a pain service team provides a feasible and safe alternative after orthopaedic surgery, pain control with a low requirement of opioids.</jats:p>
</jats:sec>