Objective: Total elbow arthroplasty (TEA) often results in severe postoperative pain requiring hospitalization to provide potent analgesia. This prospective series investigated the feasibility of converting TEA into an ambulatory procedure using a continuous infraclavicular nerve block provided at home with a portable infusion pump.
Case report: Preoperatively, patients undergoing TEA had an infraclavicular perineural catheter and peripheral nerve block placed. Postoperatively, perineural ropivacaine was delivered through postoperative day (POD) 3 to 6. Patients were discharged home when they met specific, prospectively defined criteria as early as POD 1 for the first phase and directly from the recovery room for the second phase. Of the 2 patients in the first phase who remained hospitalized for at least 1 postoperative night, both met discharge criteria in the recovery room, required no medical interventions during their admission, and were discharged home the following morning. The patient of phase 2 met discharge criteria in the recovery room and was discharged home at that time. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high for all patients.
Conclusions: These cases suggest that for a subset of patients without major comorbidities, it is feasible to convert total elbow arthroplasty into an ambulatory procedure using a continuous infraclavicular nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.