Regional Anesthesia and the Adolescent Opioid Epidemic

Abstract

Rationale: The legitimate use of prescription opioids in high school seniors increases the risk of future misuse after high school by 33%. Medial patellofemoral ligament reconstruction (MPFLR) is an operation to correct recurrent patellar instability occurring primarily in teenagers with joint hyperlaxity. MPFLR is associated with the extensive use of prescription opioids for significant postoperative pain and prolonged recovery. The hypothesis of this study is that the addition of a single injection proximal sciatic nerve block would significantly reduce opioid requirements and pain scores in adolescents undergoing MPFLR with an adductor canal continuous peripheral nerve block (CPNB). Objectives: The primary end-point of the study is cumulative post-operative opioid consumption (mg/kg morphine equivalents) while hospitalized after MPFLR between the two groups. Findings: We retrospectively compared 25 patients who received an adductor canal CPNB with a single injection proximal sciatic nerve block (Group A/S) and 23 patients who received only an adductor canal CPNB (Group A). Morphine consumption was less than half in group A/S compared to Group A. Eighty-eight percent of patients in Group A/S did not require opioids on the DOS. Maximum and mean pain scores on DOS and POD 1 were significantly lower in Group A/S than Group A. Conclusions: This study suggests the addition of a proximal sciatic nerve block to the adductor canal CPNB significantly reduces opioid requirements and pain scores in the first 24-32 hours after MPFLR in adolescent patients and supports a randomized clinical trial to confirm these findings.