Author ORCID Identifier

https://orcid.org/0009-0009-5969-4960

Semester

Summer

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Billie Vance

Committee Co-Chair

Kellon Smith

Committee Member

Lisa Pitrolo

Committee Member

Kesheng Wang

Committee Member

Joshua Sykes

Committee Member

Todd Rohrbough

Abstract

Abstract

Evaluating Outcomes Post-adoption of RECK Solution for Total Shoulder Arthroplasties: A Retrospective Quality Analysis

Benjamin Tillis

Introduction: Local infiltration analgesia (LIA) has become an integral part of postoperative pain relief for West Virginia University (WVU) Medicine’s total joint arthroplasty procedures. However, not all LIAs are the same. Liposomal bupivacaine has a unique mechanism of delivery which could potentially lead to longer lasting effects. Ropivacaine, epinephrine, clonidine, and ketorolac (RECK) solution offers a multimodal approach to enhancing the duration of effect for the LIA. In 2022, WVU Medicine switched from liposomal bupivacaine to the RECK solution for total joint arthroplasty procedures.

Purpose: It is imperative to evaluate RECK solution in postoperative analgesia outcomes for total shoulder arthroplasty patients at WVU Medicine United Hospital Center (UHC). This allows for providing the best care for the community.

Method: This project was conducted as a retrospective cohort analysis over one year from February 2022 to February 2023. This analysis was conducted at a single site and a single orthopedic surgeon. During this time, 108 patients met the project criteria and were evaluated (17 liposomal bupivacaine, 82 RECK, and 9 interscalene blocks with liposomal bupivacaine). Variables analyzed included PACU pain scores, time from phase-1 to phase-2 PACU, the total length of stay, morphine milligram equivalent consumption in PACU and the perioperative period, the presence of postoperative nausea and/or vomiting (PONV), emergency department visits within 30 days of surgery, the number of pain prescription refill requests through the electronic health record, a 6-week follow-up pain score, and variables of perioperative NSAID use, perioperative acetaminophen use, the presence of diabetes mellitus, hypertension, musculoskeletal diseases, and tobacco use.

Results: There was a statistical significance of time from phase-1 to phase-2 PACU time for RECK as compared to LB (p=0.045). The mean difference of phase-1 to phase-2 PACU time between these two groups was 35 minutes. There were no more statistically significant differences between the RECK solution and the liposomal bupivacaine group in any of the other recorded measures. However, interscalene blocks with liposomal proved superior in immediate postoperative pain scores and for decreased opioid consumption. The sample size of 108 patients is heavily skewed in favor of those who received the RECK solution due to the adopted system-wide practice change.

Conclusion: The evaluation of RECK solution compared to liposomal bupivacaine for local infiltrate analgesia of outpatient, total shoulder arthroplasty at UHC in Bridgeport, WV, demonstrates equivocal to slightly favorable postoperative pain outcomes for those who have received RECK. Widespread adoption of RECK throughout UHC’s orthopedics assisted by continued feedback via the REAIM framework could provide further measurable outcomes in the pursuit of providing excellent care to the community. Further investigation into interscalene blocks could provide meaningful outcomes for outpatient, total shoulder arthroplasty patients.

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