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A survey of perioperative nurses regarding their opinions of and preferences for peripheral nerve blocks in patients undergoing total joint replacement
Session: MP-01b
Thurs, April 19, 8-9:45 am
Uris (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.


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A Survey of Perioperative Nurses’ Opinions of and Preferences for Peripheral Nerve Blockade in Patients Undergoing Total Joint Replacement


Pain control is important to enhance recovery after total joint replacement (TJR) surgery. Regional anesthesia can provide significant pain control after TJR while also limiting the use of opioids [1,2,5,6]. Peripheral nerve blockade (PNB) may produce muscle weakness, theoretically hindering ambulation and physical therapy [3,4]. We conducted a survey of our institution’s peri-anesthesia nurses to learn their opinions on pain control modalities and their preference for analgesia based on their experience working with patients who have undergone TJR.


●23 question, anonymous, Likert-style questionnaire distributed to full-time, part-time and PRN peri-anesthesia nurses at Mayo Clinic Florida (59 nurses).
●39 surveys completed over 2 months with 1 survey omission
Question 10: In my opinion, for knee replacement surgery, PNB with local anesthetic is _______to an opioid based analgesia for post-operative pain control.
Question 11: In my opinion, for hip replacement surgery, PNB with local anesthetic is _______ to an opioid based analgesia  for post-operative pain control.
Question 12: In my opinion, for shoulder replacement surgery, PNB with local anesthetic is _____ compared to an opioid based analgesia for post-operative pain control.
Question 13: In my opinion, Lower Extremity PNB ________ the risk of patients falling.
Question 15: In my opinion, PNB ________ a patient’s recovery after lower extremity joint replacement surgery.
Question 16: In my opinion, PNB ________ a patient’s recovery after total shoulder joint replacement surgery.
Question 17: In my opinion, PNB makes patient recovery ________ for me as a perioperative nurse.
Question 18: In my opinion, PNB makes patient’s recovery ________ for the patient.
Question 19: In my opinion, PNB ________ patient’s pain after joint replacement surgery.
Question 20: In my opinion, patients having had spinal anesthesia fall ________ than patients having had general anesthesia.
Question 21: I feel that PNB  _____ a patient’s length of stay in the PACU.
Question 22: I feel that PNB _____ a patient’s risk of post-operative nausea and vomiting.
Question 23: I feel that PNB  _____ a patient’s risk of outpatient overnight observation.
●Questions 13 and 20 were answered unfavorably for PNB
●68% of nurses responded they felt PNB increase risk of falls
●20% responded they felt patients with spinal anesthesia fall more often than general anesthesia
●92% responded in favor of PNB to questions 17-19
●Most felt PNB improve patient recovery from a peri-anesthesia nursing prospective and patient’s perspective
●100% answered they would prefer a PNB if they had total hip or shoulder replacement surgeries
●95% would prefer a PNB for total knee replacement surgery
●Peri-anesthesia nurses at our institution overall have a favorable opinion of PNB and feel PNB improves patient pain control after TJR
●Literature indicates PNB provides excellent analgesia, facilitates PT, improves recovery; does not necessarily increase the risk of falls [1-6].

[1] Hebl JR, Dilger JA, Byer DE, Kopp SL, Stevens SR, Pagnano MW, et al. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 2008;33:510-7.

[2] Ilfred BM, Vandenborne K, Duncan PW, et al. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty. Anesthesiology. 2006;105(5):999–1007.

[3] Johnson RL, Kopp SL, Hebl JR, Erwin PJ, Mantilla CB. Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. Br J Anaesth 2013;110:518-28.

[4] Johnson, R. L., Duncan, C. M., Ahn, K. S., Schroeder, D. R., Horlocker, T. T., & Kopp, S. L. (2014). Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty. Anesthesia & Analgesia, 119(5), 1113-1118.

[5] Macfarlane AJR, Arun Prasad G, Chan VWS, Brull R. Does Regional Anesthesia Improve Outcomes After Total Knee Arthroplasty? Clinical Orthopaedics and Related Research. 2009;467(9):2379-2402.

[6] Turnbull ZA, Sastow D, Giambrone GP, Tedore T. Anesthesia for the patient undergoing total knee replacement: current status and future prospects. Local and Regional Anesthesia. 2017;10:1-7.

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