49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

The Effect of Multidisciplinary Education on Rebound Pain: A Retrospective Study in Primary Total Knee Arthroplasty Patients
Salvatore Daddario, BA, Inna Zinger, NP, DNP, Kara Fields, MS, Muhammad Rehman, MS, Jose Zeballos, MD, Jenna Wilson, PhD, Kristin Schreiber, MD, PhD, Yun-Yun K. Chen, MD

Background

•Regional anesthesia has been shown to decrease acute pain and post-operative opioid consumption 1

•40-50% of patients with single-shot nerve blocks report “rebound pain,” defined as acute worsening of pain with a pain rating score of ≥7/10 within 24 hours of receiving a nerve block 2, 3

•Severe acute pain associated with chronic post-surgical pain and increased opioid consumption 4

•Postoperative patient education and preemptively treating rebound pain may decrease pain severity

Aim

•To assess the impact of a multidisciplinary educational intervention aimed at reducing rebound pain (RP) in patients undergoing a primary total knee arthroplasty (TKA) who received a preoperative or intraoperative single shot adductor canal nerve block (ACB)

Methods

Educational intervention

•In-person evening rounds with orthopedic surgery resident, patient’s nurse, and anesthesia resident on the acute pain service to that patient’s nerve block will wear off and patient will require pain medication to prevent rebound pain

•Anesthesia resident provided education to the patient about pain plan after the rounding

•

Retrospective cohort study

•Inclusion criteria: primary TKA (CPT code 27447), received a preoperative or intraoperative single shot ACB, not day surgery

•Educational intervention group: March 2019 – March 2020

•Non-intervention (control) group: January 2017 – June 2018

•Variables: age, BMI, sex, ASA status, home opioid use in the last 30 days prior to surgery, type of intraoperative anesthetic, pericapsular injection received, intraoperative remifentanil use, and length of surgery

•Primary outcome: maximum pain score in the first 6-24 hours after ACB

•Secondary outcomes: mean pain score and incidence of RP 6-24 hours after ACB, postoperative opioid consumption, length of stay

References

1.Chen YK, Boden KA, Schreiber KL. The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia. 2021 Jan;76 Suppl 1(Suppl 1):8-17

2.Nobre LV, Cunha GP, Sousa PCCB, Takeda A, Cunha Ferraro LH. Bloqueio de nervos periféricos e dor rebote: revisão de literatura [Peripheral nerve block and rebound pain: literature review]. Braz J Anesthesiol. 2019 Nov-Dec;69(6):587-593

3.Muñoz-Leyva F, Cubillos J, Chin KJ. Managing rebound pain after regional anesthesia. Korean J Anesthesiol. 2020 Oct;73(5):372-383

4.Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021 Apr;126(4):862-871

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

THE EFFECT OF MULTIDISCIPLINARY EDUCATION ON REBOUND PAIN: A RETROSPECTIVE STUDY IN PRIMARY TOTAL KNEE ARTHROPLASTY PATIENTS

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