Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists’ preferences and opinions*
Robert L. McClain1, Steven B. Porter1, Scott M. Arnold2, Christopher B. Robards1
1 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
2 Department of Physical Medicine & Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
Background and Aims: Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement.
Methods: We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center.
Results: One respondent indicated they never work with patients who have undergone total joint replacement surgery. Nineteen questionnaires were included in the final analysis. Questions omitted by respondents or with write-in answers were not included in the analysis. A majority of respondents (15 [78.9%]) agreed nerve blocks somewhat to greatly improve a patient’s pain after total joint replacement surgery. Most respondents answered that nerve blocks somewhat to greatly impede a patient’s ability to participate in physical therapy (14 [73.6%]) and make therapy somewhat to very difficult for them as
physical therapists (16 [84.2%]). When asked about specific surgeries, (17/18 [94.4%]) and (14/18 [77.8%]) of respondents would prefer that their patients receive periarticular infiltration or no block at all after total knee arthroplasty or total hip arthroplasty, respectively. All respondents (19 [100%]) answered that they thought lower extremity nerve blocks increased a patient’s risk of falling after surgery.
Conclusions: According to the physical therapists we surveyed, nerve blocks impede patient recovery and increase the risk of falls, despite their positive impact on pain control. When considering surgery for themselves, therapists indicated they would not want a nerve block.
Keywords: peripheral nerve blocks; physical therapy; postoperative analgesia; postoperative recovery; total joint replacement