The Utilization of Regional Anesthesia among Pediatric Patients: A Retrospective Study

Abstract

Background The use of regional anesthesia (RA) in pediatric patients remains understudied, although evidence suggests benefits over general anesthesia. Questions/Purposes We sought to identify factors associated with RA use in patients under the age of 21 years undergoing ambulatory orthopedic surgery. Methods Patients under the age of 21 who underwent anterior cruciate ligament (ACL) repair or reconstruction, knee arthroscopy (KA), or shoulder arthroscopy (SA) were identified from the NY Statewide Planning and Research Cooperative System (SPARCS) database (2005–2015). Frequencies of RA use (defined by femoral nerve block, spinal, epidural, caudal, or brachial plexus anesthesia) were calculated. Multivariable regression analysis identified patient- and healthcare system–related factors associated with the use of RA. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Results We identified 87,273 patients who underwent the procedures of interest (ACL n = 28,226; SA n = 18,155; KA n = 40,892). In our primary analysis, 14.4% (n = 1404) had RA as their primary anesthetic; this percentage increased for patients who had ACL or KA. When adjusting for covariates, Hispanic ethnicity (OR 0.78; CI 0.65–0.94) and Medicaid insurance (OR 0.75; CI 0.65–0.87) were associated with decreased odds for the provision of RA. Further, we identified increasing age (OR 1.10; CI 1.08–1.11), ACL versus SA (OR 1.91; CI 1.74–2.10), and sports injuries (OR 1.20; CI 1.10–1.31) as factors associated with increased odds of RA use. Conclusion In this analysis, RA was used in a minority of patients under the age of 21 undergoing ambulatory orthopedic surgery. Older age was associated with increased use while Hispanic ethnicity and lower socioeconomic status were associated with lower use.

Timeout? The Epidemiology of Pediatric Sports Injuries During the COVID-19 Pandemic

“…These have been well described in the management of ACL injuries and fractures. 24 25 26 27 28 Cultural differences in seeking care and trust in the medical establishment, which have already been shown to vary between racial groups based on historic and present experiences, 29 30 31 32 33 34 may also have factored into families' decisions to seek care for less severe sports injuries during the pandemic. Given these known disparities regarding both the COVID-19 and pediatric orthopaedic care, it is possible that similar issues played a role in the results of this study.…”

Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study

“…22 However, some studies have found racial disparities in the utilization of regional anesthesia. 23,24 In a study of 1,062,152 hip and knee arthroplasty procedures, there was a significant difference between patients of color versus White patients in the utilization of regional anesthesia. 24 Patients with Medicaid or without insurance were also less likely to receive a block.…”

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

“…The inclusion of regional anesthesia in perioperative pain control regimens has been shown to be superior to opioid or non-opioid analgesic modalities alone ( 4 – 6 ). However, some studies have shown ethnic-based disparities in the use of regional anesthesia ( 1 , 7 – 11 ). For example, in a retrospective study of 639 patients in an enhanced recovery program, the use of epidural anesthesia or transversus abdominis plane (TAP) blocks was 13% lower in non-White patients than in White patients ( 1 ).…”

“…A similar observation was made in 81, 345 patients who had undergone mastectomy, where compared to White patients, the odds of receipt of regional anesthesia was up to 21% lower in non-White patients ( 9 ). Potential reasons for these disparities have included implicit bias ( 1 , 8 , 11 ), language barriers ( 10 , 11 ), and cultural preferences ( 11 ).…”