Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery

Daniel J. Cunningham, MD, MHSc; Micaela LaRose, BA; Gloria Zhang, BS; Preet Patel, BS; Ariana Paniagua, BA; Jeffrey Gadsden, MD; Mark J. Gage, MD

Disclosures

Anesth Analg. 2022;134(5):1072-1081. 

In This Article

Results

As shown in Table 1, patients without RA tended to be non-White, had higher BMI, and had higher rates of high-energy mechanism. Sixty patients received RA. All 52 peripheral nerve blockades (PNBs) were single shot and consisted of sciatic-popliteal (40.0%; n = 24), femoral (26.7%; n = 16), adductor canal (18.3%; n = 11), or fascia iliaca (1.7%; n = 1) blocks. Ten patients received EA. Single-shot spinal (11.7%; n = 7) blocks were more common than continuous epidural (5.0%; n = 3). All blocks were performed with bupivacaine or ropivacaine. One patient received liposomal bupivacaine and was excluded. Two patients received RA through both PNB and EA.

After propensity score weighting and adjustment for baseline patient and treatment factors, RA was associated with significant decreases in predicted opioid consumption from 0 to 24 hours postoperatively of approximately 5.2 oxycodone 5-mg equivalents (0.74 IRR; 0.63–0.86 CI; P < .001) and 24 to 48 hours postoperatively of approximately 2.9 oxycodone 5-mg equivalents (0.78 IRR; 0.64–0.95 CI; P = .014), as shown in Table 2 and Figure 1A–C. RA was also associated with decreased predicted outpatient opioid demand from 1 month preoperatively to 2 weeks postoperatively of approximately 24.0 oxycodone 5-mg equivalents (0.87; 0.75–0.99; P = .44) and from 1 month preoperatively to 90 days postoperatively of approximately 44.0 oxycodone 5-mg equivalents (0.83; 0.71–0.96; P = .011), as shown in Table 3 and Figure 2A–C. However, adjusted analyses demonstrated that RA was associated with a significant increase in 6-week to 90-day opioid filling (1.77, odds ratio; 1.16–2.72; P = .009) as shown in Table 4.

Figure 1.

Predicted inpatient oxycodone 5-mg equivalent consumption histogram in patients with (green) and without (red) RA. Vertical bars represent median consumption in oxycodone 5-mg equivalents. RA indicates regional anesthesia.

Figure 2.

Predicted outpatient oxycodone 5-mg equivalent prescription histogram in patients with (green) and without (red) RA. Vertical bars represent median prescription in oxycodone 5-mg equivalents. RA indicates regional anesthesia.

Supplemental Digital Contents 1–3, Appendix Tables 1–3, https://links.lww.com/AA/D892, https://links.lww.com/AA/D893, https://links.lww.com/AA/D894, demonstrate the unadjusted effect of RA on inpatient opioid consumption and outpatient opioid demand and were largely similar in direction to the adjusted statistics. However, there were fewer significant outcomes, likely related to the importance of the additional measured factors that were included in the adjusted analyses. As shown in Supplemental Digital Content 4, Appendix Table 4, https://links.lww.com/AA/D895, general 90-day outcomes were not significantly different between groups. Importantly, there were no cases of acute compartment syndrome in this cohort.

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