The impact of regional anesthesia on opioid demand in distal radius fracture surgery

Abstract

Purpose

Regional anesthesia (RA) is commonly used in distal radius fracture surgery to reduce pain and opioid consumption. The purpose of this study was to evaluate the real-world impact of RA on inpatient and outpatient opioid consumption and demand in patients undergoing distal radius fracture surgery.

Methods

All patients ages 18 and older undergoing distal radius fracture surgery between 7/2013 and 7/2018 at a single institution (n = 969) were identified. Inpatient opioid consumption and outpatient opioid prescribing in oxycodone 5-mg equivalents (OE’s) up to 90-d post-operative were recorded for patients with and without RA. Adjusted models were used to evaluate the impact of RA on opioid outcomes.

Results

Adjusted models demonstrated decreases in inpatient opioid consumption in patients with RA (10.7 estimated OE’s without RA vs. 7.6 OE’s with RA from 0 to 24 h post-op, 10.2 vs. 5.3 from 24 to 48 h post-op and 7.5 vs. 5.0 from 48 to 72 h post-op, p<.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA (65.3 OE’s without RA vs. 81.0 with RA from 1-month pre-op to 2-week post-discharge, 76.1 vs. 87.7 OE’s to 6-weeks, and 80.8 vs. 93.5 OE’s to 90-d, all p values for RA <.05) though rates of refill were significantly lower in patients with RA from 2-week to 6-week post-op compared to patients without RA.

Conclusions

Patients undergoing RA in distal radius fracture surgery had decreased inpatient opioid consumption but increased outpatient demand after adjustment for patient and operative characteristics.

Level of evidence

Level III, retrospective, therapeutic cohort study.

Keywords:

• Distal radius fracture
• regional anesthesia
• opioid

Ethical approval

This study was approved by the institutional review board.

Informed consent declaration

This retrospective, observational study did not require informed consent.

Disclosure statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. DC and MG conceived the study and obtained ethical approval. DC, ML, TK, EM, SA and AP researched literature and collected data. DC performed data analysis. DC, ML, AP and MG researched literature and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.