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LETTER TO THE EDITOR

Postoperative Analgesia and Hospital Stay: A Call for Better Study Design

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, francis.salinas{at}vmmc.org

In Response:

I agree with Dr. Kehlet (1) that our study design (2) was limited. Our primary goal was to see if one factor (better postoperative analgesia) could make enough of a difference to shorten length of stay within a very well-established clinical pathway.

Our analgesic improvement was statistically and clinically relevant. However, our intent was not to change the clinical pathway at that time, as continuous femoral nerve blocks were just starting to become more common. Although Ilfeld et al.’s pilot data (3,4) are promising, trying to decrease the length of stay for a total knee replacement or total hip replacement to one or two days, needs comprehensive management and cooperation among the orthopedic surgeon, physical medicine physicians, physical therapists, and patient. Length of stay is a function of many components, including coexisting disease, preoperative functional status, deep vein thrombosis/pulmonary embolism prophylaxis practices, postoperative blood loss, and regional anesthesia practice.

REFERENCES

1. Kehlet H. Postoperative analgesia and hospital stay: a call for better study design. Anesth Analg 2007;104:212.[Free Full Text]
2. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty of hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg 2006;102:1234–9.[Abstract/Free Full Text]
3. Ilfeld BM, Gearen PF, Enneking FK, et al. Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study. Anesth Analg 2006;102:87–90.[Abstract/Free Full Text]
4. Ilfeld BM, Gearen PF, Enneking FK, et al. Total hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study. Reg Anesth Pain Med 2006;31:113–18.[Web of Science][Medline]

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