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DO NERVE BLOCKS HINDER EARLY MOBILISATION AFTER MAJOR LOWER JOINT REPLACEMENTS?
ESRA Academy. Hii S. Sep 8, 2016; 138514
Topic: Lower Limb Blocks - Femoral Nerve Block (including Fascia Iliaca and Saphenous Nerve Block)
Stephanie Hii
Stephanie Hii

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Abstract
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Background and Aims:

Orthopaedics enhanced recovery aims for early mobilisation to reduce mortality, morbidity and overall hospital stay. Some orthopaedic surgeons in Inverclyde Royal Hospital claim that early mobilisation was not achieved with applications of regional anaesthesia to lower limb arthroplasty patients. This study assessed the impact of peripheral nerve blocks (PNB) on early mobilisation post operatively in the first 48 hours. 

Methods:

This was an observational study over 2 days post elective knee and hip replacements. Data collection looks into anaesthetic charts (type of block; volume and concentration of local anaesthetic), physiotherapy charts (pain score, motor control) and use of pain relief.

Results:

129 patients were studied (36 to 88 years old). Two main aspects looked in this study are pain scores and motor grading.

  1. 36.1 % patients who had PNB for knee surgeries had better pain score than without blocks. About 44% patients who had PNB had better motor function post operatively compared to without blocks.
  2. Patients who had PNB had just as good motor recovery compared to without any (more than 80%). Less than 20% PNB and without blocks had low pain scores. 
  3. 22 patients reported limit in mobility progress due to dizziness and vomiting.
  4. All patients received some form of regular strong opioids for postoperative analgesia. 
Conclusions:

PNB do not hinder early mobilisation although we were unable to demonstrate an improved post operative muscle strength. Non block related factors such as nausea or hypotension may be more significant in delayed mobilisation and could be due to side effects of strong opioids.

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