Implementation and Postoperative Management of Continuous Adductor Canal Catheters for Total Knee Arthroplasty to Reduce Surgical Backlog Related to the COVID-19 Pandemic: An Acute Pain Service Nursing Perspective and Educational Resource

Abstract

Purpose: In response to the surgical backlog created by the COVID-19 pandemic and to spare valuable hospital resources, we developed and implemented a continuous adductor canal catheter (CACC) program for total knee arthroplasty (TKA) patients. CACC's offer superior analgesia, decrease opioid use, and increase patient satisfaction while simultaneously promoting a decreased length of hospital stay and even same day discharges. The implementation of analgesia protocols using continuous peripheral nerve catheters and isometric pumps has been described for other surgical procedures and populations; however, the role of the Acute Pain Service Nurse (APS RN) in the implementation of such a program has not been described.

Design: An best practice initiative for TKA patients receiving CACC was developed and implemented for patients recovering both in the hospital and at home.

Methods: We describe the development and implementation of a CACC program for TKA patients in response to the surgical backlog created by the COVID-19 pandemic from the perspective of the APS RN. We provide a detailed narrative description of our postoperative assessment and experience, and offer practical insights for the postoperative care of these patients. We share the educational resources and assessment tools we developed to ensure consistent, safe, and effective clinical management of CACC patients in the hospital and at home.

Findings: CACCs via elastomeric pumps have been shown to offer significant advances to pain control following TKA, decrease opioid use, enable earlier discharge, and improve patient satisfaction, all of which we observed unequivocally in our patients. In our experience, implementation of a daily telephone follow up by an APS RN for discharged TKA patients with a CACC was crucial for patient safety, patient satisfaction, and reducing emergency phone calls and emergency room visits.

Conclusions: We anticipate this description will provide an invaluable educational resource for other Acute Pain Service programs as similar outpatient peripheral nerve catheter programs are developed in response to the pandemic.

Keywords: acute pain service (APS); continuous adductor canal catheter (CACC); nursing educational resource; surgical backlog strategies.

Figure 1

Schematic representation of the Adductor Canal Block (with catheter and infusor) and iPACK blocks. Created with BioRender.com. This figure is available in color online at www.jopan.org.

Figure 2

Standardized Follow up Assessment Form. Assessment tool used with standardized questions for follow up phone calls. GA, general anesthetic; ACB, adductor canal block; ACC, adductor canal catheter, CACC, continuous adductor canal catheter; iPACK, infiltration between the popliteal artery and capsule of the posterior knee; VAS, visual analogue score; NSAID, non steroidal anti-inflammatory drug; BID, twice daily; TID, three times daily; Saphenous N distribution, saphenous nerve distribution. This figure is available in color online at www.jopan.org.

Figure 3

Early data report: decreased opioid consumption and increased patient satisfaction. Example of early data reported to the perioperative implementation team highlighting the decrease in opioid consumption and increase in patient satisfaction seen in patients receiving a continuous adductor canal catheter (CACC) when compared to patients who received a single shot adductor canal block (ACB). Both groups also received a spinal and single shot iPACK block. This figure is available in color online at www.jopan.org.