Regional anesthesia does not decrease inpatient or outpatient opioid demand in distal femur fracture surgery

Cunningham, D. J.; Paniaugua, Ariana R.; LaRose, Micaela; DeLaura, Isabel; Blatter, Michael; Gage, Mark J.

doi:10.1007/s00402-021-03892-2

Cited by 5 publications

(2 citation statements)

References 68 publications

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“…Controversy also exists regarding the total opioid consumption after GA and RA in fracture surgeries. Several recent retrospective investigations specifically examining upper-and lower-extremity fractures have shown that RA was associated with increased inpatient and outpatient opioid demands after adjusting for baseline patient and treatment characteristics [22,25,26]. These findings contradict traditional expectations regarding the opioid-sparing effects of RA [27,28].…”

Section: Discussionmentioning

confidence: 91%

Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials

Roh,

Park,

Lee

2023

JPM

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Distal radius fractures are the most prevalent upper extremity fractures, posing a significant public health concern. Recent studies comparing regional and general anesthesia for postoperative pain management after these fractures have yielded conflicting results. This meta-analysis aimed to compare the effectiveness of regional and general anesthesia concerning postoperative pain management and opioid consumption following distal radius fracture surgery. A comprehensive search was conducted in PubMed, Cochrane Library, and EMBASE databases to identify relevant randomized controlled trials. Four randomized trials involving 248 participants were included in the analysis. A pooled analysis revealed that regional anesthesia led to significantly reduced postoperative pain scores at 2 h compared to general anesthesia (SMD −2.03; 95% CI −2.88–−1.17). However, no significant differences in pain scores were observed between the two anesthesia types after 12 h post-surgery. Regional anesthesia was associated with lower total opioid consumption (SMD −0.76; 95% CI −1.25–−0.26) and fewer occurrences of nausea and vomiting compared to the general anesthesia. Nonetheless, opioid consumption on the first day post-discharge was significantly higher in the regional anesthesia group (SMD 0.83; 95% CI 0.47–1.20). The analgesic superiority of regional anesthesia is confined to the early postoperative hours with overall lower opioid use but a notable increase in opioid consumption on the first day post-discharge, potentially attributable to rebound pain.

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Section: Discussionmentioning

confidence: 91%

Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials

Roh,

Park,

Lee

2023

JPM

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“… 25 The variations of opioid use among lower extremity fracture inpatients could be attributed to discordance in pain intensity, and ability to manage pain among orthopedic inpatients. 26 , 27 Orthopedic surgeries are some of the most traumatic, often involving reconstruction of the bone, tendon, and muscle. 28 Consequently, orthopedic surgeons often prescribe opioids to help manage the severity of pain.…”

Section: Discussionmentioning

confidence: 99%

Assessment of opioid administration patterns following lower extremity fracture among opioid-naïve inpatients: retrospective multicenter cohort study

et al. 2022

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BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Saudi Arabia have been lower extremity fractures, it is imperative to understand opioid administration patterns and correlates among opioid-naïve inpatients. OBJECTIVES: Assess opioid administration patterns and correlates among opioid-naïve inpatients with lower extremity fractures. DESIGN AND SETTINGS: Retrospective cohort PATIENTS AND METHODS: Opioid naïve individuals aged 18 to 64 years, admitted due to lower extremity fracture from 2016 to 2020 were included. Data was collected from health records of the Ministry of National Guard Health Affairs (MNG-HA) at five different medical centers. The high-dose (≥50 MME) patients were compared with low dose (<50 MME) patients. Any association between inpatient factors and high-dose opioid use was analyzed by multiple logistic regression. MAIN OUTCOME MEASURES: Opioids taken during inpatient admission as measured by milligram morphine equivalents (MME)/per day. SAMPLE SIZE: 1520 patients RESULTS: Most of the 1520 patients (88.5%) received an opioid medication, while (20.3%) received high-dose opioids at a median daily dose of 33.7 MME/per day. The proportion of patients received naloxone (20.7%) was double among high-dose opioid inpatients. High-dose opioid patients during admission were two times more likely to receive an opioid prescription after discharge (odds ratio, 2.32; 95% confidence interval, 1.53, 3.51), and three more times likely to receive ketamine during admission (odds ratio, 3.02; 95% confidence interval, 1.64, 5.54). CONCLUSION: Notable variabilities exist in opioid administration patterns that were not explained by patient factors. Evidence-based opioid prescribing practices should be developed for orthopedic patients to prevent opioid overprescribing and potential opioid overdose among orthopedic patients. LIMITATIONS: Retrospective, unmeasurable confounders might have biased our results. Since based on National Guard employees, results may not be generalizable. CONFLICT OF INTEREST: None.

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Regional anesthesia provides limited decreases in opioid use following distal tibia and ankle fracture surgery

Lantieri

Novicoff

Yarboro

2023

Eur J Orthop Surg Traumatol

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Regional anesthesia does not decrease inpatient or outpatient opioid demand in distal femur fracture surgery

Cited by 5 publications

References 68 publications

Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials

Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials

Assessment of opioid administration patterns following lower extremity fracture among opioid-naïve inpatients: retrospective multicenter cohort study

Regional anesthesia provides limited decreases in opioid use following distal tibia and ankle fracture surgery

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