A Series of Peripheral Nerve Blocks Combined With Spinal Anesthesia Is Associated With Improved Outcomes Following Total Knee Arthroplasty: A Retrospective Study

Background Peripheral nerve blocks (PNBs) are commonly used in conjunction with general anesthesia (GA) or spinal anesthesia (SA) during total knee arthroplasty (TKA). SA is associated with reduced complications, hospital length of stay (LOS), and mortality. PNBs improve the time to discharge readiness and patient satisfaction. In 2018, we implemented a set of novel, preoperative, single-injection PNBs used with SA and intraoperative sedation. We hypothesized this regime would reduce postoperative pain, opioid use, and hospital and post-anesthesia care unit (PACU) LOS and would improve ambulation. Materials and methods This retrospective study compared pain scores, hospital and PACU LOS, opioid consumption, postoperative nausea and vomiting, and postoperative ambulation between two TKA patient groups: patients who received a series of preoperative PNBs and GA (PNBs-GA) and patients who received a novel series of preoperative PNBs and SA (nPNBs-SA). Results nPNBs-SA patients demonstrated lower average and maximum pain scores (p<0.001), shorter PACU and hospital LOS (p<0.001), and greater ambulation distance (p=0.047) compared to PNBs-GA patients. After controlling for relevant covariates, there was no significant difference in ambulation distance between the groups (p=0.519). nPNBs-SA patients demonstrated greater postoperative non-opioid use (p=0.001) and lower but not significantly different postoperative opioid use (p=0.064) compared to PNBs-GA patients. Conclusions Our novel series of PNBs with SA for TKA patients may reduce postoperative pain and opioid use while also improving ambulation and shortening hospital and PACU LOS.