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KMID : 0356920160690010032
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Korean Journal of Anesthesiology
2016 Volume.69 No. 1 p.32 ~ p.36
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Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?
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:Seshadri C. Mudumbai
:Toni Ganaway/:T. Edward Kim/:Steven K. Howard/:Cynthia Shum/:Edward R. Mariano/:Nicholas J. Giori
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Abstract
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Background : Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients’ physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation.
Methods : We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status.
Results :
Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th?90th percentiles]) compared to femoral patients (0 [0?5] vs. 4 [0?10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = ?2.6; 95% CI: ?4.5, ?0.8, P = 0.01) with R2 = 0.1.
Conclusions : Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.
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KEYWORD
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Adductor canal block, Ambulation, Femoral nerve block, NumbnessPerineural catheter, Total knee arthroplasty
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