In Orthopedic Surgery, Regional Anesthesia May Reduce Opioid Use and Lead to Earlier Discharge

A new study evaluated the effectiveness of regional anesthesia via continuous catheter infusions on opioid use in orthopedic surgery patients.

“The use of regional anesthesia techniques continues to expand in a wide variety of surgical procedures as the benefits and safety are increasingly appreciated,” according to the researchers. “Limb-lengthening procedures are often associated with significant postoperative pain and high opioid requirements which may impact patient’s recovery and increase risk of chronic pain and long-term opioid use.”

This was a retrospective review of the use of a novel peripheral nerve catheter (PNC) protocol implemented to reduce pain in elective limb-lengthening patients. PNC protocol patients were assessed for total opioid consumption during the 48-hour postoperative period. Comparisons were made between patients who received general plus regional anesthesia (RA) versus general anesthesia alone (NORA), and postoperative pain needs in morphine equivalents (ME) were determined.

Final analysis included 70 patients: 41 RA patients and 29 NORA patients. Demographics were similar between the two groups. During the 48-hour postoperative period, the RA group had lower mean opioid use (0.5 kg/kg ME [interquartile range {IRQ}=0.3 to 0.9]) compared to the NORA group (1.7 mg/kg ME [IQR=1.1 to 3.1]) (P<0.001). In subgroup analyses, the researchers compared between-group outcomes for femoral lengthening and tibial-fibular lengthening procedures; “[both] lengthening procedures demonstrated the same opioid-sparing effect favoring the RA group compared to the NORA group,” the researchers observed.

In the femoral lengthening patients, the RA group had a significantly shorter hospital length of stay (32 hours [IRQ=29 to 35]) than the NORA group (53 hours [IRQ=33 to 55]). However, length of stay did not significantly differ between the groups when assessing tibial-fibular lengthening procedures.

The study was published in the Journal of Pain Research.

The study authors concluded, “Regional anesthesia via continuous catheter infusions has a clinically significant opioid-sparing effect for postoperative pain management after limb-lengthening procedures and may facilitate earlier hospital discharge.”