Abstract ID: A22
Abstract Title: Implementation of an Anesthesia Perioperative Pain Management Education Program for Peripheral Nerve Blockade in Elective Orthopedic Surgical Procedures
Poster Type: Either
ABSTRACT BODY
Introduction:The search for improved efficiency and patient outcomes in ambulatory surgery has resulted in an increased demand for peripheral nerve blocks (PNBs). Adequate perioperative pain control results in early ambulation, short hospital stay, reduced costs, decreased stress and increased patient satisfaction . Therefore, there is a need for academic centers to improve knowledge and skills of anesthesia residents with PNBs The aim of this study was to evaluate a new structured and supervised resident teaching program of peripheral nerve blocks(PNBs) for elective orthopedic surgical procedures.
Materials and Methods:A dedicated PNB rotation for anesthesia residents was initiated in February 2002, ensuring proper instruction and supervision in performing PNBs for postoperative analgesia. All blocks were performed on awake patients prior to surgery, using a peripheral nerve stimulator By residents During PNBs rotation under the supervision of anesthesia attending . After IRB approval, Analysis of hospital database from February 2002 to January 2004 identified 564 consecutive patients who underwent elective ACL reconstruction, arthroscopic shoulder surgery or ankle surgery (education group)and from January 1st 2001 to June 30th 2001 identified 187 consecutive patients who underwent the same elective surgical orthopedic procedures prior to new PNBs rotation (Reference group). PNBs were used on 539 of 564 (96%)of the Education group and 112 of 187(60%)of the reference group. Intraoperative opioid consumption, PACU time, PONV and hospital admission related to pain control or post-anesthesia complications were compared among the two groups. Statistical analysis was performed using unpaired t-test (* p<0.01).
Results:: In the reference groups, 97 ACL reconstructions were performed, of which 68 patients received femoral nerve block (FNB), 76 shoulder arthroscopies were performed, of which 44 patients received interscalene block (ISB) and 14 ankle surgeries were performed, of which 0 patients received sciatic nerve block (SNB), in the perioperative period. In the education groups, 227 ACL reconstructions were performed, of which all 227 patients received FNB, 258 shoulder arthroscopies were performed, of which 256 patients received ISB and 79 ankle surgeries were performed, of which 56 received SNB perioperatively. Intraoperative opioid use was significantly decreased in the Education Groups when compared to the Reference Groups. PACU time was decreased by an average of 45 minutes. PONV was slightly decreased. Pain-related admissions were decreased from 30% to 1%. (* p<0.01).
Discussion:The implementation of a standardized resident education program for peripheral nerve blocks for elective orthopedic surgery resulted in significantly less intraoperative opioid use, less time in PACU, and fewer number of patients admitted to hospital compared to a reference patient group who received PNB prior to the training program.
ATTACHED FILES
A22_ASRA abstract table.doc
Reg Anesth Pain Med 2004; 29(2):A22