A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty

Rovnat Babazade, Thilak Sreenivasalu, Pankaj Jain, Matthew T. Hutcherson, Amanda J. Naylor, Jing You, Hesham Elsharkawy, Ali Sakr Esa Wael, Alparslan Turan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10–20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB. Methods: With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model. Results: In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 %) patients who received a postoperative SNB and 2053 (88 %) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 % jointly maximizes the sensitivity and specificity. Conclusion: This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.

Original languageEnglish (US)
Pages (from-to)864-872
Number of pages9
JournalJournal of Anesthesia
Volume30
Issue number5
DOIs
StatePublished - Oct 1 2016

Fingerprint

Knee Replacement Arthroplasties
Nomograms
Nerve Block
Sciatic Nerve
Femoral Nerve
Electronic Health Records
Research Ethics Committees
Analgesia
Knee
Logistic Models
Physicians
Sensitivity and Specificity
Pain

Keywords

  • Nomogram
  • Postoperative pain
  • Sciatic nerve block
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Babazade, R., Sreenivasalu, T., Jain, P., Hutcherson, M. T., Naylor, A. J., You, J., ... Turan, A. (2016). A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty. Journal of Anesthesia, 30(5), 864-872. https://doi.org/10.1007/s00540-016-2223-0

A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty. / Babazade, Rovnat; Sreenivasalu, Thilak; Jain, Pankaj; Hutcherson, Matthew T.; Naylor, Amanda J.; You, Jing; Elsharkawy, Hesham; Wael, Ali Sakr Esa; Turan, Alparslan.

In: Journal of Anesthesia, Vol. 30, No. 5, 01.10.2016, p. 864-872.

Research output: Contribution to journalArticle

Babazade, R, Sreenivasalu, T, Jain, P, Hutcherson, MT, Naylor, AJ, You, J, Elsharkawy, H, Wael, ASE & Turan, A 2016, 'A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty', Journal of Anesthesia, vol. 30, no. 5, pp. 864-872. https://doi.org/10.1007/s00540-016-2223-0
Babazade, Rovnat ; Sreenivasalu, Thilak ; Jain, Pankaj ; Hutcherson, Matthew T. ; Naylor, Amanda J. ; You, Jing ; Elsharkawy, Hesham ; Wael, Ali Sakr Esa ; Turan, Alparslan. / A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty. In: Journal of Anesthesia. 2016 ; Vol. 30, No. 5. pp. 864-872.
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abstract = "Purpose: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10–20 {\%} of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB. Methods: With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model. Results: In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 {\%}) patients who received a postoperative SNB and 2053 (88 {\%}) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 {\%} jointly maximizes the sensitivity and specificity. Conclusion: This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.",
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AU - Sreenivasalu, Thilak

AU - Jain, Pankaj

AU - Hutcherson, Matthew T.

AU - Naylor, Amanda J.

AU - You, Jing

AU - Elsharkawy, Hesham

AU - Wael, Ali Sakr Esa

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N2 - Purpose: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10–20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB. Methods: With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model. Results: In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 %) patients who received a postoperative SNB and 2053 (88 %) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 % jointly maximizes the sensitivity and specificity. Conclusion: This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.

AB - Purpose: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10–20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB. Methods: With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model. Results: In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 %) patients who received a postoperative SNB and 2053 (88 %) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 % jointly maximizes the sensitivity and specificity. Conclusion: This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.

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