Retrospective Analysis of Pain After Nerve Block in Surgical Patients

Active, not recruiting

• Conditions: Regional Anesthesia Morbidity; Acute Pain; Knee Osteoarthritis
• Interventions: Other: Educational intervention

• Registration Number: NCT06042322
• Lead Sponsor: Brigham and Women's Hospital

Brief Summary

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

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.

Study Timeline

• Study Start: 2017-01-01
• Study First Submitted: 2023-08-29
• Study First Submitted QC: 2023-09-15
• Study First Posted: 2023-09-18
• Status Verified: 2024-01
• Last Update Submitted: 2024-01-08
• Last Update Posted: 2024-01-10
• Primary Completion: 2024-07-31
• Study Completion: 2024-07-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 166

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

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
TKA with nerve block with intervention	Educational intervention	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

Primary Outcome Measures

Name	Time	Method
Difference in maximum pain score, 0-10; (0 = no pain, 10 = worst pain)	6-24 hours	Difference in maximum pain score, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts

Secondary Outcome Measures

Name	Time	Method
Difference in total opioids given	6-24 hours	Difference in total opioids given (mEq of morphine) between the two cohorts
Average pain score 0-10; (0 = no pain, 10 = worst pain)	6-24 hours	Difference in area under the curve of pain scores, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts (educational intervention and non-educational intervention time periods)
Difference in incidence of rebound pain	6-24 hours	Difference in incidence pain score ≥ 7 between 6-24 hours post nerve block between the two cohorts
Comparison of evening opioids given	6-24 hours	Comparison of if evening opioids were or were not given (yes/no) between the two cohorts
Difference in length of stay	0-2 years	Difference in length of stay (days) between the two cohorts