Peripheral nerve blocks with liposomal bupivacaine are associated with increased opioid use compared to thoracic epidural in patients with an epigastric incision

2021 ◽  
Author(s):  
Taylor J. Aiken ◽  
Elena Padilla ◽  
Deborah Lemaster ◽  
Sean Ronnekleiv‐Kelly ◽  
Sharon Weber ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Thoracic Epidural

scholarly journals Use of Liposomal Bupivacaine in Pediatric Peripheral Nerve Blocks after Traumatic Amputation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Gregory M. Halenda ◽  
Stylianos Voulgarelis
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Phantom Limb ◽  
Leg Pain ◽  
Traumatic Amputation ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Nerve Blockade ◽  
Liposomal Bupivacaine ◽  
Peripheral Nerve Blockade

Liposomal bupivacaine has been explored for indications in regional anesthesia, but little has been reported about its use in pediatric patients. In March 2021, the FDA approved an indication for liposomal bupivacaine as an infiltrated local anesthetic in children older than the age of six. Despite this recently expanded indication, the literature lacks reports of use for peripheral nerve blockade in children. We describe a case where liposomal bupivacaine was used for femoral and sciatic nerve blocks in a 5-year-old child with traumatic amputation of his lower leg. Pain control was excellent, with no pain or opioid use reported during the first 62 hours. After the regional anesthesia subsided, the patient required in total 4 oral doses of oxycodone 0.1 mg/kg prior to discharge. The patient did not develop chronic pain or phantom limb syndrome. While liposomal bupivacaine is not currently FDA-approved for peripheral nerve blockade in children, this case highlights a potentially effective use of this drug and possible area for further investigation.

Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery

Hand ◽  
2020 ◽  
pp. 155894472096386
Author(s):  
Scott N. Loewenstein ◽  
Ravinder Bamba ◽  
Joshua M. Adkinson
Keyword(s):  
Emergency Department ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Emergency Department Utilization ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Increased Risk ◽  
Utilization Data ◽  
The Impact

Background The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) ( P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) ( P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.

The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management

2021 ◽  
pp. 000313482110233
Author(s):  
Taylor W. Cardwell ◽  
Vanessa Zabala ◽  
Jocelyn Mineo ◽  
Christopher N. Ochner
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Patient Reported ◽  
Postoperative Physical Therapy

Introduction The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. Methods Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms “opioid,” “morphine,” “nerve block,” “peripheral anesthesia,” “pain management,” “preoperative,”, “intraoperative,” and “postoperative” were used and combined with the Boolean terms “AND” and “OR.” This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. Results The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. Discussion Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.

Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

2019 ◽  
Vol 85 (7) ◽  
Author(s):  
Theodosios Saranteas ◽  
Iosifina Koliantzaki ◽  
Olga Savvidou ◽  
Marina Tsoumpa ◽  
Georgia Eustathiou ◽  
...  
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Acute Pain ◽  
Ultrasound Guided ◽  
Acute Pain Management ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

Fascial plane blocks and peripheral nerve blocks: two planets not so far apart

2019 ◽  
Vol 85 (10) ◽  
Author(s):  
Pierfrancesco Fusco ◽  
Eugenio Di Martino ◽  
Giuseppe Paladini ◽  
Francesca De Sanctis ◽  
Stefano Di Carlo ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Fascial Plane
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