A Retrospective Cohort Study of a Multimodal Anesthesia and Analgesia Technique for Patients Undergoing Surgery for Repair of Complex Elbow Fractures
Journal Title: Journal of Bone and Joint Diseases - Year 2018, Vol 0, Issue 0
Abstract
In the face of the opioid crisis, pressure to reduce health costs, and prevention of complications, a multimodal analgesic approach that includes regional anesthetics has become increasingly useful. ere are relatively fewer studies examining regional anesthetics in upper extremity orthopedic surgery compared to lower extremity, particularly in elbow surgery. We present an analgesic protocol for complex elbow surgery that targets multiple nociceptive pathways, prevents development of pathological pain, allows for immediate unobscured post-operative neurovascular examination, and has the majority of patients being discharged on the same day of surgery. We examined patients from 2007 to 2015 at the Los Angeles County – University of Southern California Medical Center who had elbow trauma followed by complex elbow repair. All patients received multimodal analgesia and the majority had a peripheral nerve block (PNB) catheter preoperatively that was activated with a medium duration local anesthetic. Demographic, length of stay, pain scores, and post-operative anesthesia care unit opioid use were collected. ere were no signicant differences between age and American Society of Anesthesiologists classication between patients who did receive a PNB group and those who did not. For both groups, there were no incidences of compartment syndrome or readmissions within 24 h. Length of stay for elective cases with and without a PNB was signicantly shorter than the standard 3 days length of stay aer complex elbow surgery. Between elective cases with and without a PNB, post-operative care unit pain scores, and opioid consumption were not signicantly different. Pain scores in both groups at the rst clinic visit were mild but not signicantly different. Our protocol for complex elbow surgery led to shorter lengths of stay, adequate pain control, and mild pain scores at the first clinic visit. Furthermore, this protocol allows for immediate post-operative neurovascular examination. e added benets of a continuous nerve block catheter along with multimodal analgesia prevent pathological pain from occurring. We believe this is a safe and effective protocol for upper extremity surgery that can improve patient outcomes.
Authors and Affiliations
Casper Hu Casper Hu, Michelle Lin Michelle Lin, Samantha Chau, Jack Berger
Keywords
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