Development and implementation of a regional anesthetic service by general anesthesiologists for total joint arthroplasty patients in a small community hospital in the United States

  • David P. VanEenenaam 1Department of Anesthesiology, Wake Forest School of Medicine, Winston- Salem, NC, (USA)
  • Kathleen N Johnson Department of Anesthesiology, Wake Forest School of Medicine, Winston- Salem, NC, (USA)
  • Hannah M. Harris Department of Anesthesiology, Wake Forest School of Medicine, Winston- Salem, NC, (USA)
  • Jungbin A. Choi Department of Anesthesiology, Wake Forest School of Medicine, Winston- Salem, NC, (USA)
  • Matthew W. Bullock Marshall Orthopedics, Marshall University Medical Center, Huntington, WV, (USA)
  • Daniel J. Forest Department of Anesthesiology, Wake Forest School of Medicine, Winston- Salem, NC, (USA)
  • Yvon F. Bryan Department of Anesthesiology, Dartmouth- Hitchcock Medical Center, Lebanon, New Hampshire, (USA)
DOI: https://doi.org/10.35975/apic.v23i3.1131
Keywords: Regional anesthesia, Total joint replacement, Arthroplasty, Nerve block

Abstract

Background & Objective: Regional anesthesia (RA) blocks are most commonly performed in large academic hospitals and has been shown to reduce postoperative pain. The lack of RA blocks in rural hospitals leaves a large subset of the population without availability of this service. In North Carolina, there is an increased need for these services in small community hospitals. This study examined RA nerve block success rates for total knee, hip, and shoulder arthroplasty procedures. We hypothesized that through proper mentorship, general anesthesiologists could provide safe and efficacious RA blocks at a small, community hospital.
Methodology: An Institutional Review Board (IRB) approved retrospective study was performed at Lexington Medical Center (LMC), in Lexington, North Carolina part of Wake Forest Baptist Health. We analyzed 307 patients who underwent total joint arthroplasty (195 knee, 69 hip and 43 shoulder replacements) at LMC. Demographics, type of blocks, block success, and intraoperative analgesics used were also recorded. VAS was used to assess postoperative pain.
Results: We found an overall success rate of 96.3% for all joints; 95.2%-femoral or 98.9%-adductor canal, 90.4%-lumbar plexus, 100%-interscalene block for knee, hip and shoulder arthroplasties respectively. 283/307 (92.2%) patients reported a verbal pain score between 0-2 in the PACU. There was a significantly higher mean fentanyl dose/h in patients that did not receive a lumbar plexus block for hip procedures.
Conclusion: The results of our study support that general anesthesiologists can provide rural communities with quality, specialized regional anesthesia care safely, and at an equivalent level to that of anesthesiologists specialized in RA blocks at large academic institutions.
Citation: VanEenenaam DP, Johnson KN, Harris HM, Choi JA, Bullock MW, Forest DJ, Bryan YF. Development and implementation of a regional anesthetic service by general anesthesiologists for total joint arthroplasty patients in a small community hospital in the United States. Anaesth pain & intensive care 2019;23(3):250-255

Published
10-12-2019
How to Cite
VanEenenaam, D. P., Johnson, K. N., Harris, H. M., Choi, J. A., Bullock, M. W., Forest, D. J., & Bryan, Y. F. (2019). Development and implementation of a regional anesthetic service by general anesthesiologists for total joint arthroplasty patients in a small community hospital in the United States. Anaesthesia, Pain & Intensive Care, 23(3), 250-255. https://doi.org/10.35975/apic.v23i3.1131
Issue
Vol.23 - No.3 - September - 2019
Section
Editorial Views