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

Area of Science:

• Orthopedic Surgery
• Pain Management
• Implementation Science

Background:

• The Perioperative Surgical Home (PSH) model for total knee arthroplasty (TKA) requires continuous improvement.
• Antiquated practices within the PSH model needed deimplementation and new strategies introduced.

Purpose of the Study:

• To investigate the transition from femoral nerve blocks (FNB) to adductor canal nerve blocks (ACB) in patients undergoing TKA.
• To evaluate the impact of this transition on patient outcomes and implementation facilitators.

Main Methods:

• A 13-month study (June 2016-2017) involving 435 TKA patients, divided into baseline, pilot, implementation, and evaluation periods.
• Data extracted from electronic medical records included physical therapy results and oral morphine equivalents (OME) within 30 postoperative days.
• Transition involved a significant reduction in FNB use (64% to 3%) and increase in ACB utilization (36% to 97%).

Main Results:

• Adductor canal nerve block (ACB) patients showed increased ambulation on the day of surgery (4.1 vs 2.0 m).
• ACB group experienced a lower incidence of falls (0% vs 1%) and buckling (5% vs 27%) compared to femoral nerve block (FNB) patients (P < 0.05).
• While ACB patients reported slightly lower oral morphine equivalents (OME), the difference was not statistically significant (P = 0.087).

Conclusions:

• The study successfully closed the "knowledge to action gap" within six months, demonstrating the value of implementation science in clinical practice.
• Physician education, technical support, and performance monitoring were critical facilitators for the successful transition.
• Recommendations include expanding patient populations and applying this model to additional orthopedic procedures.