Regional Anesthesia and PROMIS Scores: Enhancing Patient-Reported Outcomes Through CRNA-Led Block Programs

Understanding the Link Between Regional Anesthesia and PROMIS

In value-based orthopedic care, clinical success is no longer measured by imaging or range of motion alone. Increasingly, payers and surgeons rely on the Patient-Reported Outcomes Measurement Information System (PROMIS) to evaluate the effectiveness of care. PROMIS domains such as pain interference, physical function, fatigue, and anxiety offer a direct window into the patient experience. Regional anesthesia plays a vital role in improving these outcomes, reshaping the post-operative recovery trajectory and reducing opioid reliance. This article outlines how specific nerve block techniques, guided by Certified Registered Nurse Anesthetists (CRNAs), influence PROMIS scores and support broader surgical success.

How Regional Anesthesia Influences Key PROMIS Domains

Effective regional blocks influence several PROMIS domains:

• Pain Interference: By significantly reducing acute post-operative pain, regional blocks lower catabolic stress, leading to meaningful improvements in patient-reported pain interference. Studies show that well-executed blocks can raise this domain score by 4 to 6 points.
• Physical Function: Motor-sparing blocks, such as adductor canal blocks, facilitate early ambulation, which supports faster rehabilitation. Improvements of 3 to 5 points in physical function scores have been observed within two weeks of surgery.
• Fatigue: Opioid-sparing effects of regional anesthesia lead to improved sleep and reduced fatigue. Patients report gains of 2 to 4 points in the fatigue domain when blocks are used effectively.
• Anxiety: Patient education surrounding block procedures, combined with decreased pain intensity, contributes to reduced anxiety throughout recovery. Even modest improvements of 2 to 3 points can be clinically meaningful in outpatient settings.

In PROMIS methodology, a five-point increase represents one standard deviation—an effect size large enough to be both clinically relevant and statistically significant, even in small sample sizes.

Clinical Evidence Supporting PROMIS Improvements With Regional Blocks

Evidence continues to build around the effectiveness of regional anesthesia in improving PROMIS outcomes. In a randomized controlled trial of 150 ambulatory total knee arthroplasties (TKAs), patients receiving an adductor canal block combined with an IPACK block reported significantly better PROMIS Pain Interference scores at post-operative day 7, averaging 56 compared to 63 in those receiving femoral nerve blocks (p < 0.01).

Similarly, a prospective cohort study of 82 patients undergoing shoulder arthroplasty found that those receiving a low-volume interscalene block with dexamethasone achieved an eight-point improvement in the PROMIS Upper Extremity domain at six weeks compared to patients who received general anesthesia alone. Blocks that preserve motor function and minimize opioid exposure are consistently associated with the largest gains across multiple PROMIS domains.

Enhancing PROMIS Scores Through CRNA-Led Patient Communication

Patient education provided by CRNAs has a measurable impact on PROMIS scores, particularly in anxiety and pain-related domains. Structured messaging at key touchpoints helps set expectations and improve outcomes. Examples include:

• During preoperative block consent, CRNAs explain that the patient will likely ambulate earlier due to motor-sparing effects, which supports better physical function scores.
• In the post-anesthesia care unit, patients are advised to begin oral pain medication before the block wears off, helping reduce breakthrough pain and improving pain interference scores.
• Six hours after surgery, patients may receive a follow-up text asking them to rate their pain and encouraging movement of the feet. This type of contact has been shown to reduce anxiety and support patient engagement.

One facility that implemented scripted CRNA messages observed a three-point improvement in the PROMIS Anxiety domain compared to standard care.

Integrating PROMIS Data Into Clinical Operations

Efficient data collection is key to making PROMIS-based anesthesia programs actionable. A typical data flow includes:

• Collecting baseline PROMIS scores using a computer-adaptive test (CAT) during the preoperative clinic visit.
• Sending automated follow-up surveys via email at post-operative days 7 and 30.
• Aggregating results in a centralized dashboard such as Power BI, with filtering options by block type, provider, and surgical specialty.
• Reviewing heat maps of domain performance monthly to adjust block volumes, techniques, or adjuvant use.

This level of tracking allows anesthesia teams to tailor their practices and continuously improve outcomes based on patient-reported data.

Understanding Return on Outcome (ROO) for Regional Anesthesia

Improved PROMIS scores do not only reflect better patient care—they also support financial and reputational returns. In one use case, patients receiving regional anesthesia achieved physical therapy milestones faster. For example, reaching 100 degrees of knee flexion took 4.9 sessions on average with a block versus 6.4 sessions without, resulting in a $290 savings in physical therapy costs per patient.

Net Promoter Scores (NPS) also rose from 62 to 84 when regional anesthesia was implemented, indicating higher patient satisfaction. In bundled payment models, exceeding a PROMIS threshold score of 55 triggered an 8 percent bonus payout, equating to an additional $400 per case.

Building a PROMIS-Aligned Regional Anesthesia Program

Facilities aiming to implement a PROMIS-driven anesthesia strategy should focus on the following priorities:

• Standardize block protocols by procedure, such as using 20 mL of 0.2 percent ropivacaine with dexamethasone for adductor canal blocks.
• Utilize adjuvants such as dexamethasone or clonidine to extend block duration beyond initial physical therapy sessions.
• Train CRNAs in structured, patient-facing communication that improves satisfaction and sets realistic expectations.
• Link PROMIS outcomes to internal anesthesia quality metrics and recognize providers when score benchmarks are met or exceeded.
  

Conclusion

Regional anesthesia is a strategic tool that extends well beyond the intraoperative period. When integrated with outcome tracking systems like PROMIS and supported by skilled CRNA communication, nerve blocks can significantly improve the domains that matter most to patients, payers, and surgical teams. Orthopedic practices that prioritize high-success block programs supported by consistent data collection position themselves to thrive in a value-based care environment.