Regional Anesthesia Decreases Early Perioperative Opioid Demand but Increases Late Opioid Demand in Ankle and Distal Tibia Fracture Surgery

CATEGORY: Ankle; Trauma INTRODUCTION/PURPOSE: Regional anesthesia (RA) is commonly used in ankle and distal tibia surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient opioid demand in patients undergoing ankle and distal tibia fracture surgery. METHODS: All patients ages 18 and older undergoing ankle and distal tibia fracture surgery at a single institution between 7/2013 and 7/2018 were included in this study (n=1,310). Inpatient opioid consumption (0-72 hours post-operative) and outpatient opioid prescribing (1-month pre-operative to 90-days post-operative) were recorded in oxycodone 5-mg equivalents (OE's). Adjusted models were used to evaluate the impact of RA on inpatient and outpatient opioid demand. RESULTS: Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OE's without RA vs 8.8 OE's with RA from 0-24 hours post-op, p<0.001) but no significant difference after that time (9.7 vs 10.4 from 24-48 hours post-op, and 9.5 vs 8.5 from 48-72 hours post-op). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all timepoints (112.5 OE's without RA vs 137.3 with RA from one-month pre-op to two- weeks, 125.6 vs 155.5 OE's to 6-weeks, and 134.6 vs 163.3 OE's to 90-days, all p-values for RA <0.001). Figure demonstrates a histogram of the inpatient opioid consumption in patients with and without RA. CONCLUSION: In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient opioid demand after adjusting for baseline patient and treatment characteristics. These findings provide information on the real-world impact of RA and temper enthusiasm for perioperative nerve blockade.