Regional anesthesia does not decrease opioid demand in pelvis and acetabulum fracture surgery

2021 ◽  
Author(s):  
Daniel J. Cunningham ◽  
J. Patton Robinette ◽  
Ariana R. Paniagua ◽  
Micaela A. LaRose ◽  
Michael Blatter ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Acetabulum Fracture ◽  
Fracture Surgery

Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery

2021 ◽  
pp. 175857322110481
Author(s):  
Daniel J. Cunningham ◽  
Micaela A. LaRose ◽  
Gloria X. Zhang ◽  
Ariana R. Paniagua ◽  
Christopher S. Klifto ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Proximal Humerus ◽  
Rebound Effect ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Opioid Consumption ◽  
Humeral Shaft ◽  
Patients Âgés ◽  
The Impact ◽  
Fracture Surgery

Introduction Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Materials and methods Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 – 7/2018 (n = 380 patients). Inpatient opioid consumption from 0–24, 24–48, and 48–72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Results Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0–24 h post-op; 10 vs 13.7 from 24–48 h post-op; and 8.7 vs 11.6 from 48–72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. Discussion In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

Regional anesthesia for scapular fracture surgery: an educational review of anatomy and techniques

2020 ◽  
pp. rapm-2020-101819
Author(s):  
Kartik Sonawane ◽  
J Balavenkatasubramanian ◽  
Hrudini Dixit ◽  
Harshitha Tayi ◽  
Vipin Kumar Goel
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Combine Approach ◽  
Scapular Fracture ◽  
Surgical Interventions ◽  
Scapular Fractures ◽  
Fracture Surgery ◽  
The Way

Scapular fractures are very rare, and those requiring surgical interventions are even rarer. Most scapula surgeries are done under general anesthesia with or without the regional anesthesia (RA) technique as an adjunct. Since scapular innervation is complicated, a thorough review of the relevant anatomy is warranted. In this RAPM educational article, we aimed to summarize the target nerves and blocks needed to optimize analgesia or even to provide surgical anesthesia for scapula surgeries. In this review, we are describing an algorithmic “identify-select-combine” approach, which enables the anesthesiologist to understand detailed innervation of the scapula and to obtain a procedure-specific RA technique. Procedure-specific RA would probably be the way forward for defining future RA practices.

scholarly journals Effectiveness of additional thoracic paravertebral block in improving anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

2020 ◽  
Author(s):  
xiaofeng wang ◽  
Hui Zhang ◽  
Zhenwei Xie ◽  
Qingfu Zhang ◽  
Wei Jiang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Brachial Plexus ◽  
Regional Anesthesia ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Cervical Plexus ◽  
Thoracic Paravertebral Block ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Abstract Background: The innervation of shoulder-upper extremity area is complicated and unclear. Regional anesthesia with brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. Methods: The patients aged 65 or older, referred for anterior approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at surgical area, proportion of patients who need rescue anesthesia (intravenous remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients. Discussion: This RCT aims to confirm whether additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.

scholarly journals Comparative Effectiveness of Regional versus  General Anesthesia for Hip Fracture Surgery in Adults

2012 ◽  
Vol 117 (1) ◽  
pp. 72-92 ◽  
Author(s):  
Mark D. Neuman ◽  
Jeffrey H. Silber ◽  
Nabil M. Elkassabany ◽  
Justin M. Ludwig ◽  
Lee A. Fleisher
Keyword(s):  
Hip Fracture ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Odds Ratio ◽  
Cardiovascular Complications ◽  
Pulmonary Complications ◽  
Inpatient Mortality ◽  
Hip Fracture Surgery ◽  
Subgroup Analyses ◽  
Fracture Surgery

Background Hip fracture is a common, morbid, and costly event among older adults. Data are inconclusive as to whether epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery. Methods The authors examined a retrospective cohort of patients undergoing surgery for hip fracture in 126 hospitals in New York in 2007 and 2008. They tested the association of a record indicating receipt of regional versus general anesthesia with a primary outcome of inpatient mortality and with secondary outcomes of pulmonary and cardiovascular complications using hospital fixed-effects logistic regressions. Subgroup analyses tested the association of anesthesia type and outcomes according to fracture anatomy. Results Of 18,158 patients, 5,254 (29%) received regional anesthesia. In-hospital mortality occurred in 435 (2.4%). Unadjusted rates of mortality and cardiovascular complications did not differ by anesthesia type. Patients receiving regional anesthesia experienced fewer pulmonary complications (359 [6.8%] vs. 1,040 [8.1%], P &lt; 0.005). Regional anesthesia was associated with a lower adjusted odds of mortality (odds ratio: 0.710, 95% CI 0.541, 0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637, 0.887, P &lt; 0.0001) relative to general anesthesia. In subgroup analyses, regional anesthesia was associated with improved survival and fewer pulmonary complications among patients with intertrochanteric fractures but not among patients with femoral neck fractures. Conclusions Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia; this finding may be driven by a trend toward improved outcomes with regional anesthesia among patients with intertrochanteric fractures.

Sign in / Sign up

Export Citation Format

Share Document