The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management

Abstract

Introduction The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. Methods Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms “opioid,” “morphine,” “nerve block,” “peripheral anesthesia,” “pain management,” “preoperative,”, “intraoperative,” and “postoperative” were used and combined with the Boolean terms “AND” and “OR.” This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. Results The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. Discussion Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.

Utilizing Peripheral Nerve Blocks for Pain Management in Pediatric Patients during Embolization and Sclerotherapy for Vascular Malformations

“…This study showed an association between reduced MME/kg usage and pain scores in the block group, indicating that nerve blocks are associated with reduced MMEs in selected patients. This finding is consistent with using peripheral nerve blocks in other surgeries [ 11 , 12 , 13 ]. Minimizing pain and discomfort can improve the child’s and parents’ overall experience and reduce anxiety.…”

Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage – A pilot observational study

“…Peripheral nerve blocks (PNBs) have been effective in treatment of acute and chronic headache disorders that involve the trigeminalovascular system, such as migraines, neuralgias, tension-type and chronic headaches ( 12–14 ). PNBs reduce headache intensity, duration and opioid usage ( 14 , 15 ). Recently, a case report described success of a greater occipital nerve block for HASH in two patients ( 16 ).…”

The Impact of Peripheral Nerve Block on the Quality of Care After Ankle Fracture Surgery: A Quality Improvement Study

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