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THE KEY TO OPTIMIZING POSTOPERATIVE PATIENT EXPERIENCES

THINK BEYOND THE TABLE

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Postoperative patient satisfaction in joint replacement surgery is significantly affected by how well a patient’s pain is managed.1-4 And, opioid-based postoperative pain management is resulting in poor patient experiences, due to adverse opioid side effects.1-2,5-8 Opioids may cause side effects5,9-12 (eg, nausea and vomiting, constipation, sedation), all of which compromise the main goal of a rapid10,13-20 and functional recovery.

ON Q Patient Sat Joint Replacement ON Q Narcotics Postsurgical

Effective management of postoperative pain creates a great patient experience1-3,7,10,13

Pain Managemnt Chart

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  2. Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder: a doubleblind, randomized controlled trial. J Bone Joint Surg [Br]. 2006;88B:1173 1177.
  3. Husain A, Lee GC. Establishing realistic patient expectations following total knee arthroplasty. J Am Acad Orthop Surg. 2015;23(12):707713.
  4. Hamilton DF, Lane JV, Gaston P, et al. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open. 2013;3:e002525 doi:10.1136/bmjopen2012002525.
  5. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11:s105s120.
  6. Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of singleshot interscalene block please stand up? Asystematic review and metaanalysis. Anesth analg. 2015;120(5):11141129.
  7. Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized, doubleblind trial of local anesthetic infusion and intravenous narcotic patientcontrolled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122(4):10101018.
  8. Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:120.
  9. Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by ONQ pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008;101(6):841847.
  10. Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914932.
  11. The Joint Commission. Safe use of opioids in hospitals. Sentinel Event Alert. Issue 49, August 8, 2012.
  12. American Academy of Orthopedic Surgeons. Opioid use, misuse, and abuse in orthopaedic practice. Information Statement 1045. http://www.aaos.org/about/statements/advisements/. Published October 2015. Accessed February 2016.
  13. Beaussier M, El’Ayoubi H, Schiffer E, et al. Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery. Anesthesiology. 2007;107(3):461468.
  14. Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy ofropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth. 2003;91(6):830835.
  15. White PF, Rawal S, Latham P, Markowitz S, et al. Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology. 2003;99(4):918923.
  16. Auyong DB, Allen CJ, Pahang JA, Clabeaux JJ, MacDonald KM, Hanson NA. Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthroplasty. 2015;30(10):17051709.
  17. Mudumbai SC, Kim TE, Howard SK, et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014;472(5):13771383.
  18. Capdevila X, Barthelet Y, Biboulet P, Ryckwart Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on thesurgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91(1):815.
  19. Ilfeld BM, Ball ST, Gearen PF, et al. Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty: a dualcenter, randomized, triplemasked, placebocontrolled trial. Anesthesiology. 2008;109(3):491501.
  20. Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth. 2010;105(2):185195.
  21. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003 Aug;97(2):534-540.
  22. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011 Jun 1;93(11):1075-84.
  23. Webb C, Mariano E. Best multimodal analgesic protocol for total knee arthroplasty. Pain Management. 2015;5(3):185-196.
  24. Dine A. Evidence based outcomes review. Continuing review and evaluation for I-Flow Corporation. July 2012.
  25. Goyal N, McKenzie J, Sharkey PF, Parvizi J, Hozack WJ, Austin MS. The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res. 2013;471(1):64-75.
  26. Gómez-Cardero P, Rodríguez-Merchán EC . Postoperative analgesia in TKA: ropivacaine continuous intraarticular infusion. Clin Orthop Relat Res. 2010;468(5):1242-1247.
  27. Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth. 2010;105(suppl 1):86-96.
  28. Dowling R, Thielmeier K, Ghaly A, Barber D, Boice T, Dine A. Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial. J Thorac Cardiovasc Surg. 2003;126(5):1271-1278.