title: A retrospective comparative provider workload analysis for femoral nerve and adductor canal catheters following knee arthroplasty.
abstract: Adductor canal catheters preserve quadriceps strength better than femoral nerve catheters and may facilitate postoperative ambulation following total knee arthroplasty. However, the effect of this newer technique on provider workload, if any, is unknown. We conducted a retrospective provider workload analysis comparing these two catheter techniques; all other aspects of the clinical pathway remained the same. The primary outcome was number of interventions recorded per patient postoperatively. Secondary outcomes included infusion duration, ambulation distance, opioid consumption, and hospital length of stay. Adductor canal patients required a median (10-90th percentiles) of 0.0 (0.0-2.6) interventions compared to 1.0 (0.3-3.0) interventions for femoral patients (p < 0.001); 18/23 adductor canal patients (78 %) compared to 2/22 femoral patients (9 %) required no interventions (p < 0.001). Adductor canal catheter infusions lasted 2.0 (1.4-2.0) days compared to 1.5 (1.0-2.7) days in the femoral group (p = 0.016). Adductor canal patients ambulated further [mean (SD)] than femoral patients on postoperative day 1 [24.5 (21.7) vs. 11.9 (14.6) meters, respectively; p = 0.030] and day 2 [44.9 (26.3) vs. 22.0 (22.2) meters, respectively; p = 0.003]. Postoperative opioid consumption and length of stay were similar between groups. We conclude that adductor canal catheters offer both patient and provider benefits when compared to femoral nerve catheters.
authors.affiliation: Regional Anesthesiology and Acute Pain Medicine Fellow, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rasmussen
authors.forename: Eugenia
authors.initials: E
authors.lastname: Kim
authors.forename: T Edward
authors.initials: TE
authors.lastname: Kim
authors.forename: Steven K
authors.initials: SK
authors.lastname: Howard
authors.forename: Seshadri
authors.initials: S
authors.lastname: Mudumbai
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giori
authors.forename: Steven
authors.initials: S
authors.lastname: Woolson
authors.forename: Toni
authors.initials: T
authors.lastname: Ganaway
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D057785:Catheters; D005260:Female; D005267:Femoral Nerve; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D013848:Thigh; D016896:Treatment Outcome; D016138:Walking; D016526:Workload / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid