Enhanced Recovery After Major Surgery and Chronic Pain for Total Knee Arthroplasty

The cumulative opioid consumption 72hours, 96 hours, and 1 week post block administration. Measured in morphine milligram equivalents per day.

Although collected over a period of time, the total amount will be summed and the average will be reported.

Patients are asked to give a number between 0 and 10 that best fits their pain intensity. The scale is 0 = 'no pain at all' whereas 10 = 'the worst pain ever possible'.

Measured at multiple time points: DOS, post-operative day (POD) 1, POD 2, POD 3, POD 4, POD 7, \& POD 60

Collected from the physical therapy notes. This outcome will assess for time to ambulation (measured in distance traveled, stairs, time of ambulating > 30 meters, and reaching discharge criteria).

Patients are asked to report on their satisfaction with pain control on a scale of 0 to 10, with 0 = extremely dissatisfied and 10 = extremely satisfied.

From when the patient is in the PACU to when the patient has been discharged from the hospital. PACU time = "PACU Transfer In" and Discharge time = "Discharge"

The Opioid-Related Symptom Distress Scale (ORSDS) is a 4-point scale that evaluates 3 symptom distress dimensions (frequency, severity, bothersomeness) for 12 symptoms. The symptom-specific ORSDS is the average of the 3 symptom distress dimensions. The composite ORSDS is the average of 12 symptom-specific scores.

Whether a participant experiences buckling, falls, or quadricep weakness during physical therapy, precluding ambulation.

Whether the participant experienced any blood loss during their surgical procedure.

Measured in binary responses (yes/no).

The patient will be asked in the morning of POD 1 when they feel the block has worn off, and in the evening of POD 3 after the catheter has been removed.

The total distance of ambulation during physical therapy while the patient is inpatient, collected from the physical therapy notes.

Patient will be asked if they have experience any of the following with regards to the catheter:

delayed weakness, unintentional dislodgment, leakage, catheter infection, dysesthesias, falls, LAST

Whether the patient was readmitted to a hospital for additional pain control.

Patients will report if they experience any block complications including, neuropraxia (saphenous), transient palsies: peroneal, tibial nerve.

The survey asks for patients' view about their knee, such as how they feel about their knee and how well they are able to do usual activities. Choices on each question are: none, mild, moderate, severe, extreme

Patient will be asked about their range of motion (flexion ROM and Extension ROM). Data collected from surgeon's note

The SF-36 measures includes the following: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH).

Measured on a scale of 1 to 3, with 1 = "yes limited a lot", 2 = "yes limited a little", 3 = "no not limited at all".

The total score for each participant is calculated and then all the scores are average across all participants.

The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) comprises of a 7-item pain scale, including the sensory descriptors and items for sensory examination.

Out of the seven items in the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), five are symptom related and two are examination items.

If patient reports surgery-related pain greater than 3 on the NRS at the 3 months and 6 months postoperative visit, patient will complete this questionnaire.

The Current Opioid Misuse Measure (COMM) is a commonly used self-report instrument to identify and monitor aberrant opioid-related behavior in chronic pain patients on opioid therapy.

At the 3 months and 6 months postoperative visit, if patients are still being prescribed opioids, patient will be asked to fill out the questionnaire

Choices on the questionnaire are:

never, seldom, sometimes, often, very often

Research staff will mark if patients contacted the pain doctor via the Diagnotes application.

Patients will be asked at 1 week post-operation, about their pain medication usage (how many pills of your opioid medication do you have left?)

The Pain Catastrophizing Scale (PCS) assesses the extent of catastrophic thinking due to low back pain according to 3 components: rumination, magnification, and helplessness. It is a 13-item scale, with a total range of 0 to 52. Higher scores are associated with higher amounts of pain catastrophizing.

The Pain Disability Index (PDI) is a widely-used instrument to measure pain-related disability.

Scoring: Scores are assigned based on an 11-point scale ranging from 0 (no disability) to 10 (total disability). Scores range from 0 to 70. The higher the index the greater the person's disability due to pain.

Patient and research staff will report which group they believe the patient was randomized to.

Data on whether patient experienced quadriceps weakness and foot drop during physical therapy. Collected from physical therapy notes.

Research staff will document any non-opioid pain medications (lyrica, robaxin, tyelnol, etc) taken by each participant. Medications may be given at the discretion of the APS service.

Research staff will document if patient received IV PCA during their stay at the hospital. Measured in morphine equivalent.

Discharge times can vary from participant to participant (from POD 0 up until POD 2)

The time it takes for the patient to be induced. Measured from induction start to induction end.

Times for each participants will be calculated (in minutes) and then average across all participants.

The total time to use a tourniquet. Measured from tourniquet inflated time tourniquet deflated time.

Times for each participants will be calculated (in minutes) and then average across all participants.