Regional anesthesia does not decrease inpatient or outpatient opioid demand in femoral shaft fracture surgery.

Autor: Cunningham DJ; Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710, United States. Electronic address: daniel.cunningham@duke.edu., LaRose MA; Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States., DeLaura IF; Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States., Zhang GX; Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States., Paniagua AR; Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States., Gage MJ; Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710, United States.
Jazyk: angličtina
Zdroj: Injury [Injury] 2021 Oct; Vol. 52 (10), pp. 3075-3084. Date of Electronic Publication: 2021 Jul 15.
DOI: 10.1016/j.injury.2021.07.020
Abstrakt: Introduction: Regional 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.
Methods: Inpatient 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.
Results: Adjusted 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) DISCUSSION: In 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 Evidence: Level III, retrospective, therapeutic cohort study.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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