Background/Purpose: Total knee arthroplasty (TKA) increasingly affects a significant amount of Americans. It is estimated by 2030 there will be a 673% increase on TKA, up to 3.48 million per year as compared to the current 600,000 per year. TKAs typically require 2-3 day hospital stay and months of physical therapy. Individuals undergoing TKA most likely have suffered years of increasingly debilitating pain and dysfunction. Various types of anesthesia and analgesia's are used for total joint procedures and can affect the patients rehab outcome. The purpose of this study is to investigate the affects of different anesthesia and analgesia on rehabilitation outcomes in the acute setting. Factors that can affect rehabilitation outcomes and which will be investigated in this study include: rehabilitation indices (knee flexion, extension, ambulation), length of stay and adverse effects (DVT or PE, hypotension, nausea, vomiting, pruitius, sedation). Case Description: One 65yr old female undergoing TKA, whom suffered for greater than 4 years of increasing pain and decreasing independence with ADLs and recreational activities due to osteoarthritis, was used for this study. She received both a femoral and sciatic block, as well as general anesthesia. Methods: An extensive and comprehensive evidence based literature search was conducted using four different databases which included PubMEd, CINAHL Plus, Cochrane, and Science Direct. A wide literature search for studies related to different effects and outcomes of anesthesia and analgesia techniques on TKA outcome was conducted. Eight articles were ultimately best suited to answer the clinical question and were then reviewed, analyzed and discussed. In addition, a retrospective case study on a 65yr old female was performed and factors that could influence rehabilitation outcomes were assessed. Outcomes: Most research showed no statistically significant difference in rehabilitation outcomes such as knee ROM, ambulation distance and length of hospital stay. Pain scores may vary slightly amongst different analgesia interventions, however the difference was no bigger than 2/10 on the VAS and it did not significantly impact physical therapy rehabilitation. Peripheral nerve block, whether continuous or single shot, femoral nerve or a combination of femoral and sciatic or PSOAS compartment, showed no significant difference with other regional techniques such as spinal or epidural. General anesthesia typically accompanies these blocks, though sometimes is used instead of spinal or epidural along with peripheral. In these instances, episodes of hypotension or side effects such as nausea, vomiting or sedation may be slightly higher, as evidence by data leaning towards, however it was not statistically significant. Discussion/Conclusion: Although the woman in the case study experienced adverse reactions to the anesthesia and analgesia used (nausea, vomiting) and missed nearly a full day of therapy on post-op day 1, by discharge, she met all established discharge goals, did not stay additional hospital days, was able to ambulate and had similar ROM for other individuals discharged after undergoing TKA.
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anasthesia, analgesia, total knee, athroplasty, rehabilitation outcomes, acute
Luna, Leslie. "The Effects of Different Anesthesia and Analgesia Used for Individuals Undergoing Total Knee Athroplasty on Rehabilitation Outcomes in the Acute Setting.." (2014). http://digitalrepository.unm.edu/dpt/48
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