The use of regional techniques by certified registered nurse anesthetists (CRNAs) in patients undergoing total knee arthroplasty is an effective alternative to general anesthesia, reduces postoperative pain, and shortens outpatient recovery time. The purpose of this research was to compare the postoperative analgesic requirements and hospital length of stay for patients undergoing total knee arthroplasty following two different types of regional anesthesia, combined spinal-epidural (CSE) and femoral-sciatic nerve block (FSNB). The Neuman system model guided this research. This descriptive, comparative study examined postoperative pain in 50 surgical patients undergoing total knee replacement using retrospective chart reviews. The differences in analgesic requirements and length of stay by type of regional anesthesia were studied. In this sample, 24 (48%) received a FSNB and 26 (52%) received a CSE. Mean narcotic usage among the FSNB group was greater as shown by the patient controlled analgesia (PCA) usage on all days evaluated (POD 1, t=2.47, p=.017; POD 2, t=3.84, p<.001; POD 3, t=2.31, p=.025). Mean oral narcotic usage was shown to be greater for the FSNB group on day three only (POD 3, t=2.1, p=.041). Mean NSAID usage for the CSE group was greater on day two through four (POD 2, t=-3.9, p=<.001; POD 3, t=-2.9, p=.005; POD 4, t=-3.2, p=.002). No difference was found in length of stay between groups. Threats to validity included a lack of sufficient documentation regarding pain management. Implications of this study include the need for larger, prospective studies and inclusion of additional outcome measures such as patient satisfaction. CRNAs should use studies such as this one in their practice to decide which type of regional anesthesia will work most effectively.
Session #1223 - Graduate Student Poster Session
The 29th Annual MNRS Research Conference (April 1-4, 2005)