Implementation science for the adductor canal block:A new and adaptable methodology process  

作　　者：Nikhil Crain Chun-Yuan Qiu Stephen Moy Shawn Thomas Vu Thuy Nguyen Mijin Lee-Brown Diana Laplace Jennifer Naughton John Morkos Vimal Desai 

机构地区：[1]Bowman Gray Center for Medical Education,Wake Forest School of Medicine,Winston-Salem,NC 27103,United States [2]Perioperative Service and Anesthesiology,Kaiser Permanente Medical Center,Baldwin Park,CA 91706,United States [3]Department of Anesthesiology,Baldwin Park Medical Center,Southern California Kaiser Permanente Medical Group,Baldwin Park,CA 91706,United States [4]Johns Hopkins University,The Johns Hopkins University School of Medicine,Baltimore,MD 21205,United States

出　　处：《World Journal of Orthopedics》2021年第11期899-908,共10页世界骨科杂志（英文版）

摘　　要：BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.

关 键 词：Total knee arthroplasty Femoral nerve block Adductor canal block Physical therapy Oral morphine equivalent Action-related information gap 

分 类 号：R614[医药卫生—麻醉学]