General Anesthesia Without Nerve Block Is Non-Inferior to General Anesthesia with Nerve Block for Postoperative Pain Control in Antegrade Femoral Limb Lengthening: A Retrospective Study.

: Effective postoperative pain management is essential in femoral limb lengthening surgery. Although regional nerve blocks reduce pain and opioid use, their benefit in antegrade femoral intramedullary limb lengthening is unclear. This study compares postoperative pain and opioid consumption in patients receiving general anesthesia (GA) alone versus GA with a preoperative femoral or fascia iliaca nerve block. : A retrospective review included 192 patients who underwent femoral lengthening with intramedullary telescoping nails between January 2012 and October 2023 at a single center. Patients were categorized into Group A (GA alone, = 131) and Group B (GA plus nerve block, = 61). Primary outcomes were postoperative mean and maximum pain scores in the first 24 h, total opioid pills prescribed at discharge, and total morphine milligram equivalents (MMEs) used in the Post-Anesthesia Care Unit (PACU). Non-inferiority was defined by a margin of one standard deviation for pain scores and opioid usage. : Demographics were similar between groups. Maximum PACU pain scores were 3.8 for Group A and 3.3 for Group B ( > 0.05); mean pain scores were 2.1 and 1.9, respectively ( > 0.05). GA alone was non-inferior for pain control. However, total opioid pills prescribed at discharge were higher in Group A (23.2) than Group B (10) ( < 0.05). PACU MME usage was also higher in Group A (26 vs. 18.4 ± 15 mg, < 0.05), though non-inferiority criteria were met. : GA alone is non-inferior to GA with nerve block for postoperative pain management following antegrade femoral intramedullary limb lengthening. Although patients without a nerve block received more opioids at discharge, their pain control remained similarly effective. Given potential risks and the lack of clear pain reduction benefits, routine nerve block use may not be warranted. Decisions regarding nerve block application should be individualized, considering patient preferences, surgeon recommendations, and anesthesiologist input.