Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710, United States.
Duke University School of Medicine, Duke University Medical Center 3710, Durham, NC 27710, United States.
Injury. 2021 Oct;52(10):3075-3084. doi: 10.1016/j.injury.2021.07.020. Epub 2021 Jul 15.
Regional anesthesia (RA) may be used in femoral shaft fracture surgery to decrease pain and opioid consumption. However, the impact of RA on inpatient and outpatient opioid demand in patients undergoing femoral shaft fracture surgery is largely unknown. The aim of this study was to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand in patients undergoing femoral shaft fracture surgery.
Inpatient opioid consumption and outpatient opioid demand in all patients undergoing femoral shaft fracture surgery was recorded at a single, Level I trauma center from 7/2013 - 7/2018 (n=436). In addition to RA, baseline and treatment factors including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery were recorded. Unadjusted and adjusted multivariable models were used to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand.
Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.9 estimated OE's without RA vs 8.8 OE's with RA from 48-72 hours post-op, p<0.05) but no significant differences at other timepoints (10.3 estimated OE's without RA vs 9.2 OE's with RA from 0-24 hours post-op, 8.2 vs 8.8 from 24-48 hours post-op, p>0.05). Estimated cumulative outpatient opioid demand did not differ significantly in patients with RA (82.3 OE's without RA vs 94.8 with RA from discharge to two-weeks, 105.4 vs 116.3 OE's to 6-weeks, and 124.5 vs 137.9 OE's to 90-days, all p>0.05). Late opioid refills were significantly more common in patients with RA (1.57 odds at 2-weeks to 6-weeks, 1.69 odds at 6-weeks to 90-days, p<0.05) DISCUSSION: In femoral shaft fracture surgery, RA was not associated with decreased opioid demand after adjusting for baseline patient and treatment characteristics. These results provide a real-world estimate of the impact of RA on opioid demand in femoral shaft fracture surgery and encourage providers to seek alternative analgesic modalities.
Level III, retrospective, therapeutic cohort study.
区域麻醉（RA）可用于股骨干骨折手术，以减少疼痛和阿片类药物的消耗。然而，RA 对股骨干骨折手术患者的住院和门诊阿片类药物需求的影响在很大程度上尚不清楚。本研究旨在评估 RA 对股骨干骨折手术患者住院期间阿片类药物消耗和门诊阿片类药物需求的影响。
在一家单一的一级创伤中心，从 2013 年 7 月至 2018 年 7 月（n=436）记录所有接受股骨干骨折手术的患者的住院期间阿片类药物消耗和门诊阿片类药物需求。除了 RA 外，还记录了基线和治疗因素，包括年龄、性别、种族、体重指数（BMI）、吸烟、慢性阿片类药物使用、美国麻醉医师协会（ASA）评分、损伤机制、附加损伤、开放性损伤和附加住院手术。使用未调整和调整后的多变量模型来评估 RA 对住院期间阿片类药物消耗和门诊阿片类药物需求的影响。
调整后的模型显示，RA 患者的住院期间阿片类药物消耗增加（无 RA 时为 6.9 个估计 OE，有 RA 时为 48-72 小时后为 8.8 OE，p<0.05），但在其他时间点无显著差异（无 RA 时为 10.3 个估计 OE，有 RA 时为 9.2 OE，0-24 小时后，8.2 对 8.8，24-48 小时后，p>0.05）。RA 患者的门诊阿片类药物需求估计累计量无显著差异（无 RA 时为 82.3 OE，有 RA 时为 94.8 OE，出院至两周，105.4 对 116.3 OE，至 6 周，124.5 对 137.9 OE，至 90 天，均为 p>0.05）。RA 患者的晚期阿片类药物再填充明显更为常见（2 周至 6 周时为 1.57 倍，6 周至 90 天为 1.69 倍，p<0.05）。
在股骨干骨折手术中，调整基线患者和治疗特征后，RA 与阿片类药物需求减少无关。这些结果提供了 RA 对股骨干骨折手术中阿片类药物需求影响的真实世界估计，并鼓励提供者寻求替代镇痛方式。
三级，回顾性治疗队列研究。
