Table 1.
Comparison of protocol and clinical pathway used for the treatment groups.
| Cases with an Ambulatory CFNB | Controls with a Hospitalized CFNB | Costs/Charges Included? | |
|---|---|---|---|
| Pre- and Intraoperative | |||
| Preoperative clinic visit | Shands Hospital | Same | Yes |
| Surgical procedure | Primary, unilateral, tricompartment, cemented TKA via a 12–18 cm midline incision and parapatellar approach | Same | Yes |
| ASA Physical Status | 2 | Same | N/A |
| Femoral catheter placed | Regional anesthesia induction area | Same | Yes |
| Perineural infusion local anesthetic | Ropivacaine 0.2% initiated in the operating room | Same | Yes |
| Perineural infusion basal infusion rate | 8 mL/h until day of discharge, then 5 mL/h | 5–10 mL/h | N/A |
| Perineural infusion bolus dose and lockout | 4 mL bolus; 30 min lockout until POD 1, then 60 min | 2–5 mL bolus; 20–30 min lockout | N/A |
| Primary anesthetic | Sevoflurane, nitrous oxide | Inhalation agent, not specified | Yes |
| IV fluids | Hetastarch 15 mL/kg | Not specified | Yes |
| Recovery room supplemental analgesic | IV morphine | Same | Yes |
| Cases with an Ambulatory CFNB (n=10) | Controls with a Hospitalized CFNB (n=10) | Cost/Charges Included? | |
| Postoperative/Hospitalized | |||
| Hospital unit | General Clinical Research Center | General orthopedic unit | Yes |
| Scheduled analgesics | Controlled-release oxycodone 10 mg every 12 h and acetaminophen 975 mg every 6 h | Same | Yes |
| DVT prophylaxis | Enteric-coated aspirin 650 mg daily | Same | Yes |
| Supplemental analgesics | Oxycodone 5–10 mg (NRS ≤ 7) IV morphine (NRS > 7) | Oxycodone 5–10 mg and IV morphine (NRS ranges not specified) | Yes |
| Transfusion | 2 units packed red blood cells for hematocrit < 30 | Same | Yes |
| Duration of CFNB | Catheter removed at home on postoperative day 4 | Catheter removed in the hospital at surgeon’s discretion | Yes |
| Pain management | Anesthesiologist | Anesthesiologist during CFNB, then orthopedic surgeon | Yes |
| Physical therapy | Twice daily until discharge | Same | Yes |
| Primary discharge criteria | NRS consistently ≤ 4
IV morphine < 5 mg previous 24 h Ambulate > 30 m |
NRS: same
IV morphine: same Ambulate > 24–30 m |
N/A |
| Home management | |||
| Scheduled analgesics | Controlled-release oxycodone 10 mg every 12 h and acetaminophen 975 mg every 6 h | Same | No |
| DVT prophylaxis | Enteric-coated aspirin 650 mg daily | Same | No |
| Supplemental analgesics | Oxycodone 5–10 mg | Same | No |
| Home nursing visit | Day following discharge | Same | Yes |
| Home physical therapy | Daily through postoperative day 5 | Same | Yes |
| Pain management | Anesthesiologist (available by pager and daily phone calls) | Orthopedic surgeon (available by pager) | Yes |
ASA: American Society of Anesthesiologists
N/A: Not applicable
TKA: total knee arthroplasty
CFNB: continuous femoral nerve block
DVT: deep vein thrombosis
NRS: numeric rating pain scale