Objective: Total elbow arthroplasty (TEA) often results in severe postoperative pain requiring hospitalization to provide potent analgesia. This prospective series investigated the feasibility of converting TEA into an ambulatory procedure using a continuous infraclavicular nerve block provided at home with a portable infusion pump.
Case Report: Preoperatively, patients undergoing TEA had an infraclavicular perineural catheter and peripheral nerve block placed. Postoperatively, perineural ropivacaine was delivered through postoperative day (POD) 3 to 6. Patients were discharged home when they met specific, prospectively defined criteria as early as POD 1 for the first phase and directly from the recovery room for the second phase. Of the 2 patients in the first phase who remained hospitalized for at least 1 postoperative night, both met discharge criteria in the recovery room, required no medical interventions during their admission, and were discharged home the following morning. The patient of phase 2 met discharge criteria in the recovery room and was discharged home at that time. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high for all patients.
Conclusions: These cases suggest that for a subset of patients without major comorbidities, it is feasible to convert total elbow arthroplasty into an ambulatory procedure using a continuous infraclavicular nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.
- Ambulatory surgery
- Continuous nerve block
- Continuous peripheral nerve block
- Patient-controlled regional analgesia
- Perineural local anesthetic infusion
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Supported by the University of Florida Department of Anesthesiology, Smiths Medical, Arrow International, and the National Institutes of Health (National Institute of General Medical Sciences, Grant GM077026). Supported in part by General Clinical Research Center Grant M01-RR00082. Manufacturers donated the portable infusion pumps (Smiths Medical) and perineural catheters (Arrow International) used for this investigation.
The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the above entities. Smiths Medical and Arrow International had no input into any aspect of study conceptualization, initiation, and design; data collection, analysis, and interpretation; or manuscript preparation.