Retrospective Analysis of Pain After Nerve Block in Surgical Patients

Retrospective Analysis of Pain in Patients Who Receive a Nerve Block for Surgery

This is a retrospective study looking at patients who received a nerve block for surgery and assessing pain after the nerve block resolves, with or without an educational intervention, over two periods of time.

Study Overview

• Status: Active, not recruiting
• Conditions: Knee Osteoarthritis; Acute Pain; Regional Anesthesia Morbidity
• Intervention / Treatment: Other: Educational intervention

Detailed Description

Regional anesthesia (RA) is a vital tool that can serve as the primary anesthetic or as part of a multimodal perioperative pain regimen. RA is strongly associated with decreased acute and persistent pain and opioid consumption postoperatively. However, some patients experience an acute worsening of pain into the severe range around the time of RA resolution, also known as "rebound pain" (RP). The incidence of RP has been reported as high as 40-50% after a single shot nerve block for patients undergoing ambulatory surgery.

This retrospective study aims to look at patients who received a nerve block for surgery and assessing pain after the nerve block resolves in the presence and absence of certain interventions, such as a multidisciplinary educational intervention.

The investigators will assess patients who received a primary total knee arthroplasty who received a single shot adductor canal nerve block, received pericapsular injection by the surgeon, and had a length of stay > 16 hours.

• Study Type: Observational
• Enrollment (Estimated): 166

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Using the Mass General Brigham Enterprise Data Warehouse, electronic health record data will be retrieved: adult patients, 18 years of age or older, who received a primary total knee arthroplasty, an adductor canal nerve block, pericapsular injection, and admitted to stay overnight (>16 hours post nerve block).

Description

Inclusion Criteria:

• primary total knee arthroplasty
• received an adductor canal nerve block
• received pericapsular injection by surgeon intraoperatively
• admitted for overnight stay and > 16 hours post-nerve block

Exclusion Criteria:

• age < 18
• prior total knee arthroplasty on ipsilateral knee

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
TKA with nerve block with intervention; Patients who received a single shot adductor canal nerve block prior to total knee arthroplasty surgery during March 2019-March 2020, and received an educational intervention	Other: Educational intervention; Multidisciplinary educational intervention was performed by orthopedic, anesthesia, and nursing team. This included a discussion of the patient's pain plan and a patient visit.
TKA with nerve block no intervention; Patients who received a single shot adductor canal nerve block prior to total knee arthroplasty surgery January 2017-June 2018

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in maximum pain score, 0-10; (0 = no pain, 10 = worst pain)	Difference in maximum pain score, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts	6-24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average pain score 0-10; (0 = no pain, 10 = worst pain)	Difference in area under the curve of pain scores, numerical pain rating scale 0-10, 6-24 hours after nerve block between the two cohorts (educational intervention and non-educational intervention time periods)	6-24 hours
Difference in incidence of rebound pain	Difference in incidence pain score ≥ 7 between 6-24 hours post nerve block between the two cohorts	6-24 hours
Comparison of evening opioids given	Comparison of if evening opioids were or were not given (yes/no) between the two cohorts	6-24 hours
Difference in total opioids given	Difference in total opioids given (mEq of morphine) between the two cohorts	6-24 hours
Difference in length of stay	Difference in length of stay (days) between the two cohorts	0-2 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of evening opioids given	Comparison of if evening opioids were or were not given (yes/no) between the two cohorts	8-16 hours
Difference in total opioids given	Difference in total opioids given (mEq of morphine) between the two cohorts	8-16 hours
Difference in length of stay	Difference in length of stay (days) between the two cohorts	0-30 days

Collaborators and Investigators

• Sponsor: Brigham and Women's Hospital
• Investigators: Principal Investigator: Yun-Yun K Chen, MD, Brigham and Women's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2017
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: August 29, 2023
• First Submitted That Met QC Criteria: September 15, 2023
• First Posted (Actual): September 18, 2023

Study Record Updates

• Last Update Posted (Actual): April 28, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Osteoarthritis, Knee; Acute Pain; Health Services; Health Care Facilities Workforce and Services; Child Health Services; Community Health Services; Preventive Health Services; Early Intervention, Educational
• Other Study ID Numbers: 2023P000514

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No