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Implementation science for the adductor canal block:A new and adaptable methodology process

World Journal of Orthopedics 2021年第11期12卷 899-908页

作者： Nikhil Crain Chun-Yuan Qiu Stephen Moy Shawn Thomas Vu Thuy Nguyen Mijin Lee-Brown diana laplace Jennifer Naughton John Morkos Vimal Desai Bowman Gray Center for Medical Education Wake Forest School of MedicineWinston-SalemNC 27103United States Perioperative Service and Anesthesiology Kaiser Permanente Medical CenterBaldwin ParkCA 91706United States Department of Anesthesiology Baldwin Park Medical CenterSouthern California Kaiser Permanente Medical GroupBaldwin ParkCA 91706United States Johns Hopkins University The Johns Hopkins University School of MedicineBaltimoreMD 21205United States

BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new *** To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during *** Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were *** within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 *** in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<*** By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation *** education,technical support,and performance monitoring were deemed key facilitators of our program’s *** patient populations and additional orthopedic procedures are recommended for future study.

关键词： Total knee arthroplasty Femoral nerve block Adductor canal block Physical therapy Oral morphine equivalent Action-related information gap

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作者： P.L.·拉普拉斯(P.L. laplace)

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