Continuous peripheral nerve blocks for pain control after orthopaedic surgery: A prospective study during in-hospital and ambulatory care.

Abstract

Background: Continuous peripheral nerve blocks (CPNB) provide an opioid-free alternative for pain control after orthopaedic surgery. However, postdischarge ambulatory patient care and follow-up concerns have prevented CPNB use at home.

Objective: To address physicians' concerns about the outpatient use of CPNB.

Design: Prospective, cohort, observational study.

Setting: Single centre, teaching private hospital in Santiago, Chile, between July 2016 and March 2020.

Patients: We included patients aged at least 18 who underwent orthopaedic surgery using CPNB for postoperative pain management. Patients scheduled simultaneously for non-orthopedic surgery on the same event were excluded.

Main outcome measures: Pain scores, opioid use, and complication rates at both in-hospital and at-home sites.

Results: CPNB were provided as an analgesia plan in 497 patients who met inclusion criteria, and 387 (77.87%) were discharged home with this continuous analgesia. At 48 h, 70% of the patients reported no-worse-than-mild pain. Less than 3.1% of patients reported an episode of severe pain, and less than 13% of the patients required opioid rescue medication. Transient neurological symptoms were observed in 13% (95% confidence interval (CI), 10.4 to 16.1) of the patients. No long-term or severe complications were observed. High rates of satisfaction were reached among patients.

Conclusion: In-hospital and at-home use of CPNB supervised by a pain service team provides a feasible and safe alternative after orthopaedic surgery, pain control with a low requirement of opioids.