Regional anesthesia does not decrease inpatient or outpatient opioid demand in femoral shaft fracture surgery |
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| Affiliation: | 1. Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710, United States;2. Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States;1. Department of Emergency Medicine, Balıkesir Atatürk City Hospital, Balıkesir, Turkey;2. Department of Neurosurgery, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey;3. Department of Neurosurgery, Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey;4. Department of Pathology, Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey;5. Department of Biochemistry, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey;6. Department of Anatomy, Lokman Hekim University, Faculty of Medicine, Ankara, Turkey;7. Department of Neurosurgery, Mersin VM Medical Park Hospital, Mersin, Turkey;8. Department of Neurosurgery, İstinye University, Faculty of Medicine, Istanbul, Turkey;1. Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children''s Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, Zhejiang Province, 325000, PR China;2. The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, PR China.;1. Institution: AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, Tobelbad 8144, Austria;2. Institution: Department of Orthopaedics and Trauma Surgery, Medical University of Graz, Graz, Austria;3. Institution: AUVA Trauma Hospital Graz, Graz, Austria |
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| Abstract: | IntroductionRegional anesthesia (RA) may be used in femoral shaft fracture surgery to decrease pain and opioid consumption. However, the impact of RA on inpatient and outpatient opioid demand in patients undergoing femoral shaft fracture surgery is largely unknown. The aim of this study was to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand in patients undergoing femoral shaft fracture surgery.MethodsInpatient opioid consumption and outpatient opioid demand in all patients undergoing femoral shaft fracture surgery was recorded at a single, Level I trauma center from 7/2013 – 7/2018 (n=436). In addition to RA, baseline and treatment factors including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery were recorded. Unadjusted and adjusted multivariable models were used to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand.ResultsAdjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.9 estimated OE's without RA vs 8.8 OE's with RA from 48-72 hours post-op, p<0.05) but no significant differences at other timepoints (10.3 estimated OE's without RA vs 9.2 OE's with RA from 0-24 hours post-op, 8.2 vs 8.8 from 24-48 hours post-op, p>0.05). Estimated cumulative outpatient opioid demand did not differ significantly in patients with RA (82.3 OE's without RA vs 94.8 with RA from discharge to two-weeks, 105.4 vs 116.3 OE's to 6-weeks, and 124.5 vs 137.9 OE's to 90-days, all p>0.05). Late opioid refills were significantly more common in patients with RA (1.57 odds at 2-weeks to 6-weeks, 1.69 odds at 6-weeks to 90-days, p<0.05)DiscussionIn femoral shaft fracture surgery, RA was not associated with decreased opioid demand after adjusting for baseline patient and treatment characteristics. These results provide a real-world estimate of the impact of RA on opioid demand in femoral shaft fracture surgery and encourage providers to seek alternative analgesic modalities.Level of evidenceLevel III, retrospective, therapeutic cohort study |
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