title: Pain management after total knee arthroplasty: a case–control study of continuous nerve block therapy.
abstract: BACKGROUND
  Continuous femoral nerve block infusions (CFNBIs) have been found to both decrease patient postoperative pain and improve postoperative joint mobilization, both of which impact patient satisfaction, outcome, and length of stay. When we began the use of CFNBIs, we needed to create a policy, process, standing order form, and staff education plan as well as a means to maximize therapy efficacy and believed that a research study would best meet those needs.
  
  
  OBJECTIVE
  To evaluate the patient response to the institution of CFNBI therapy, identify process improvement areas, and suggest areas for future study.
  
  
  METHODS
  Through retrospective chart review, using a case–control research design with 27 pairs of patients matched by body mass index, American Society of Anesthesiologists patient physical status classification, and age, we examined whether patients receiving CFNBI therapy after total knee arthroplasty would report less postoperative pain, require less narcotics, and achieve mobilization goals earlier than patients receiving traditional narcotic analgesia only.
  
  
  RESULTS
  The CFNBI case group reported significantly less pain over the fi rst three postoperative days ( p = .05), but findings revealed no significant differences between case and control groups in total narcotic use or achievement of mobility goals. On the basis of this study, we increased the CFNBI drug concentration and expect that this will allow us to meet all 3 patient goals.
  
  
  CONCLUSIONS
  This study has added to previous research that supports CFNBI as a proven therapy to decrease postoperative pain in patients undergoing total knee arthroplasty. The structure of a research project facilitates the implementation, evaluation, and improvement of such new therapies. Evaluating patient data allows identification of process improvement areas—in our case, the change in drug concentration—as well as the need for staff education aimed at facilitating their active participation in CFNBI therapy.
authors.forename: Karenirene
authors.initials: K
authors.lastname: Thomas
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.forename: Ruth
authors.initials: R
authors.lastname: Tupper
authors.forename: Lydia
authors.initials: L
authors.lastname: Dacenko-Grawe
authors.forename: Karyn
authors.initials: K
authors.lastname: Holm
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D006801:Humans; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies