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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

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

Introduction:

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.

Methods:

●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
 
Questionaire:
 
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.
 
Discussion:
 
●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].
 
References:
 

[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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