broad agreement. More than three-fourths (77%) say they've reduced
the doses of opioids they prescribe at discharge, and 73% say their pain
management for total knees is "very effective." (About 21% say it's
"somewhat effective," and 6% admit it's "not as effective as [they'd]
like.")
"This is something I've been working on for many years," says ortho-
pedic surgeon Gary Levengood, MD, who's performed hundreds of
outpatient total knees at the Gwinnett Medical Center in Duluth, Ga.
"I've always been interested in finding something so that when
patients wake up, they're not in extreme agony. So I started asking
what other people were doing."
His quest led to a multimodal approach that includes regional nerve
blocks, NSAIDs, liposomal bupivacaine (Exparel), antiemetics and
acetaminophen. The difference compared to years past, he says, is
remarkable.
"Patients who had
surgery 3 or 4 years
ago who are coming
back to have their
other knee done
look at me like I'm
crazy when I say we
can now do it outpa-
tient," he says. "They
remember how
much agony they
were in for a long
time after the first
surgery. Now, they
may end up having
J a n u a r y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 9 1
adductor canal blocks are likely gaining ground, as
evidence suggests they do a better job of hastening
mobility in total-knee patients.
BLOCK CHOICE
Single Shots Top the List
If you use regional blocks, which types do you use?
SOURCE: Outpatient Surgery Magazine reader Survey,
December 2016, n=138
Femoral single-shot block 57.25%
Femoral catheter 12.32%
adductor canal single-shot block 42.75%
adductor canal catheter 18.84%
Sciatic (or tibial) single-shot block 13.77%
Sciatic catheter 1.45%
iPaCK block 8.70%
