Background and aims Total knee arthroplasty (TKA) patients at Phelps Health received continuous femoral nerve block (FNB) with single injection distal sciatic block (SNB), providing excellent analgesia; however, motor weakness was noted. Novel techniques have shown decreased length of stay utilizing continuous adductor canal block (ACB) with single injection iPACK (infiltration between the popliteal artery and knee capsule) block. This retrospective study, after ethics approval, compared two regional techniques (continuous FNB with single injection SNB versus continuous ACB with single injection iPACK) on hospital length of stay, physical therapy performance, opioid consumption, and readmission rates in 188 patients undergoing TKA.
Methods Patients in the control group received continuous FNB and single injection SNB. Patients in the experimental group received continuous ACB and single injection iPACK block. Intraoperative and postoperative opioid consumption, physical therapy performance in the recovery unit, hospital length of stay, and readmission rates were recorded and analyzed.
Results No significant differences were noted with regard to patient demographics. There was no difference noted in physical therapy performance in PACU; however, hospital length of stay was significantly reduced in the ACB with iPACK group versus FNB with sciatic block (p=0.005). No increase in hospital readmissions was noted at 30 and 60 days postoperatively.
Conclusions Continuous adductor canal with iPACK nerve blocks led to significantly decreased hospital length of stay. This did not affect emergency room visits or readmission rates at 30 and 60 days when compared to femoral with sciatic nerve blocks when undergoing TKA. Results were similar to those noted at large academic centers.
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