The effect of regional anesthesia blocks on post-operative pain after ambulatory orthopedic trauma surgery.

Abstract

To determine if regional anesthesia had added benefit to general anesthesia, with or without local anesthesia, in controlling post-operative pain in outpatient orthopedic trauma surgery. A retrospective review was performed of prospectively gathered data on 71 patients undergoing outpatient orthopedic trauma surgery. All patients received general anesthesia and an addition 52 patients received additional regional anesthesia. Regional vs. no regional anesthesia groups were compared in terms of post-anesthesia care unit (PACU) pain visual analog scores (VAS), PACU length of stay (LOS), opioid use, and pain control at two weeks. The regional anesthesia group not differ in demographics or proportion of patients receiving local anesthesia, but was less likely to be undergoing major procedures (13% vs. 37%, proportional difference (PD) -23%; 95% confidence interval (CI) -46% to -0.4%). There were no detectable differences in PACU opioid requirements (median difference (MD) -7.5mg, CI -8 to 0), PACU LOS (MD -13min, CI -63 to 24), discharge pain VAS (MD 0, CI -1 to 1), post-discharge pain VAS (MD 0, CI -1 to 1), opioid refills (PD -6%, CI -31% to 18%), or patient-perceived pain control (PD -24%, CI -41% to 0%). On multivariate analysis, regional anesthesia was the only variable negatively associated with patient-perceived pain control at two weeks (Odds Ratio 0.15; 95% CI 0.03 to 0.8). Regional anesthesia did not improve post-operative opioid requirements, PACU LOS, or patient-reported pain in the immediate or short-term post-operative period.