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  • EP050 Anesthetic and analgesic management in outpatient primary knee and hip arthroplasty: a systematic review focused on patient-centered outcomes

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ePoster session 2 – Station 2
EP050 Anesthetic and analgesic management in outpatient primary knee and hip arthroplasty: a systematic review focused on patient-centered outcomes
  1. Alberto Ardon1,
  2. Jinlei Li2,
  3. Rebecca Johnson3,
  4. Nigel Gillespie1,
  5. Jean-Pierre Ouanes4,
  6. Ashley Shilling5,
  7. Hanae Tokita6 and
  8. Sylvia Wilson7
  1. 1Anesthesiology, Mayo Clinic, Jacksonville, USA
  2. 2Anesthesiology, Yale, New Haven, USA
  3. 3Anesthesiology, Mayo Clinic, Rochester, USA
  4. 4Anesthesiology, Hospital for Special Surgery, West Palm Beach, USA
  5. 5Anesthesiology, University of Virginia, Charlottesville, USA
  6. 6Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, USA
  7. 7Anesthesiology, Medical University of South Carolina, Charleston, USA

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Many institutions are facilitating the use of outpatient pathways for total knee arthroplasty (TKA) and total hip arthroplasty (THA). Our primary purpose in this systematic review is to assess evidence regarding the impact of neuraxial anesthesia, periarticular injection (PAI), and peripheral nerve blocks (PNB) on patient-centered outcomes for outpatient TKA and THA.

Methods A task force of Society for Ambulatory Anesthesia (SAMBA) and American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) experts in regional anesthesia participated in this endeavor. PICO (population, intervention, comparison, outcome) questions were engineered to address the use of neuraxial anesthesia, periarticular injection, and peripheral nerve blocks on time to discharge, time to first ambulation, and pain scores. A standardized systematic approach was used in the review of the literature. MEDLINE, Embase, and Cochrane databases were queried.

Results The literature search yielded 3010 studies; 239 articles were assessed to be valid for formulation of our review. Only 2 studies assessed outcomes in the outpatient setting. The use of spinal anesthesia is associated with decreased postoperative pain and length of stay. The use of PAI is supported in both TKA and THA. Peripheral nerve blocks can decrease pain even in the presence of PAI among TKA patients.

Abstract EP050 Figure 1
Abstract EP050 Figure 1

PRISMA flow diagram for systematic review

Abstract EP050 Figure 2
Abstract EP050 Figure 2

Bias assessments for randomized controlled trials

Conclusions Overall, our findings indicate that, while evidence exists to support the use of spinal anesthesia, periarticular infiltration, and peripheral nerve blocks, more research is needed to assess the potential impact of these techniques in an outpatient arthroplasty setting.

  • outpatient
  • arthroplasty
  • patient-centered outcomes.

https://doi.org/10.1136/rapm-2024-ESRA.123

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