Association of Nerve Block and Opioid Administration for Patellar Surgery

Abstract

Introduction: Multimodal pain control after orthopaedic surgery is a topic of growing interest in opioid-related risk mitigation. However, little evidence exists in the orthopaedic trauma setting. We aim to analyze the impact of perioperative peripheral nerve blocks (PNB) on opioid pain management in patients undergoing open reduction and internal fixation (ORIF) of patella fractures. Methods: This analysis included 47 patients with isolated patella fractures who underwent ORIF (2017-2021). Our dedicated PNB service provided 28 cases with PNBs. Extracted variables during hospitalization included demographic data, pain scores on visual analog scale (VAS), intra-, and postoperative opioid administration measured as morphine milligram equivalents (MME). Follow-up data included prescription refills, ED visits for pain within 90 days, and VAS pain scores. Chi-squared and logistic regression analyses were performed to evaluate the impact of PNB on opioid based pain management. Results: Patients with a PNB had lower average total MME (126.54±18.96) than those without a PNB (160.62±35.81); however, this was not statistically significant (p = 0.201). Use of PNB was not associated with total prescription refills, ED visits, or pain on VAS for all time points. However, at two-weeks follow-up, patients without PNB had 4x higher odds of receiving a refill (OR:4.13, CI:1.13-15.10). Subgroup analysis revealed no significant association between PNB timing (preoperative/postoperative) and intraoperative, postoperative, or total inpatient MME. Conclusion: With the observed inconsequential effect of PNB, findings suggest that opioid administration in the orthopaedic trauma population is multifaceted. Continued conscious prescribing practices with multimodal pain control should be encouraged to mitigate opioid-related risks.