ABSTRACT
Inadequate pain management after total knee arthroplasty (TKA) can interfere with participation in and progression of physical rehabilitation, and thereby prolong hospital stay, and increase costs and overall dissatisfaction with the procedure. At our institution, TKA traditionally has been performed with femoral nerve catheters (FNCs) for postoperative pain control. We conducted a retrospective, longitudinal, repeated -measures study to compare FNC and long-acting liposomal bupivacaine (LALB) with respect to pain control, range of motion, ability to ambulate, and hospital length of stay. Twenty-three patients underwent separately staged bilateral TKAs, the first with FNC and the second with periarticular injection of LALB. Statistically significant differences favoring LALB over FNC were found for hospital length of stay (P < .01), per-attempt walking distance during hospitalization (P < .01), total range of motion (extension plus flexion) at 3-week follow-up (P = .02), and total morphine-equivalent dose during hospitalization (P = .02). Our results showed that, compared with patients who received FNC, patients who received LALB had comparable pain control, improved knee range of motion, and shorter hospital stays. Additional clinical studies are needed to better determine the efficacy and cost-effectiveness of LALB and other long-acting local anesthetic formulations.
Subject(s)
Anesthetics, Local/therapeutic use , Arthroplasty, Replacement, Knee/methods , Bupivacaine/therapeutic use , Nerve Block/methods , Pain, Postoperative/drug therapy , Aged , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Female , Femoral Nerve , Humans , Length of Stay , Liposomes , Male , Middle Aged , Pain Measurement , Range of Motion, Articular , Retrospective Studies , Treatment OutcomeABSTRACT
The purpose of this study was to compare nasal povidone-iodine swab for total joint arthroplasty patients to methicillin-resistant Staphylococcus aureus (MRSA) screening on the incidence of 90-day postoperative surgical site infections in total knee and hip arthroplasties as well as the cost-effectiveness. This is a single-center retrospective review of primary or revision total knee or hip arthroplasty patients. There were 849 patients screened for MRSA and 1004 patients in the nasal swab groups, both with an infection rate of 0.8%. The mean cost for the nasal swab was $27.21 (SD, 0), significantly different (P ≤ .01) than the mean cost for MRSA screens, $121.16 (SD, 26.18). There were significant cost savings with no difference in infection rates; therefore, nasal povidone-iodine swab antiseptic is financially and clinically successful.