Korean J Anesthesiol.
2016 Feb;69(1):32-36. 10.4097/kjae.2016.69.1.32.
Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?
- Affiliations
-
- 1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA. emariano@stanford.edu
- 2Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA.
- 3Department of Orthopaedic Surgery, Stanford University School of Medicine, CA, USA.
- 4Surgical Service, Orthopaedic Surgery Section, Veterans Affairs Palo Alto Health Care System, CA, USA.
- KMID: 2152857
- DOI: http://doi.org/10.4097/kjae.2016.69.1.32
Abstract
- BACKGROUND
Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients' physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation.
METHODS
We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status.
RESULTS
Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th-90th percentiles]) compared to femoral patients (0 [0-5] vs. 4 [0-10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = -2.6; 95% CI: -4.5, -0.8, P = 0.01) with R2 = 0.1.
CONCLUSIONS
Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.
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Cited by 1 articles
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The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial
Min Kyoung Kim, Hyoung Yong Moon, Choon Gun Ryu, Hyun Kang, Han Jun Lee, Hwa Yong Shin
Korean J Pain. 2019;32(1):30-38. doi: 10.3344/kjp.2019.32.1.30.
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