Regional anesthesia does not decrease opioid demand in pelvis and acetabulum fracture surgery

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

“…Among system-based strategies, we identified 22 studies on hospital-based protocols to limit or improve opioid prescriptions ( n = 13) [ 77 – 83 , 89 , 90 , 92 , 96 , 97 , 102 ] or formal government regulation in some U.S. states to limit opioid prescriptions ( n = 9) [ 85 – 88 , 91 , 93 , 103 – 105 ]. Among pharmacological strategies, we identified 18 studies [ 62 – 76 , 94 , 98 , 99 , 106 ], which mainly focused on the effect of anesthetic agents administered through regional anesthesia ( n = 8) [ 62 , 65 , 70 , 73 , 74 , 94 , 98 , 99 ] and the impact of medication on the central nervous system [ 63 , 66 , 67 , 69 ] ( n = 4) and opioid use. The educational strategies comprised seven studies on strategies aimed at providing patient information on the adequate use of opioids ( n = 6) [ 5 , 50 , 51 , 53 , 100 , 107 ] or aimed as a reminder to professionals on opioid prescribing guidelines ( n = 1) [ 52 ].…”

“…Data came from patient records or clinical-administrative databases ( n = 27) [ 5 , 60 , 73 , 74 , 78 – 81 , 83 – 89 , 91 , 94 , 98 , 101 – 105 , 108 , 110 , 112 , 114 ], or a combination of these methods, and from patient self-report ( n = 17) [ 53 , 55 , 58 , 62 , 63 , 65 , 68 , 71 , 72 , 77 , 82 , 90 , 96 , 100 , 107 , 109 , 113 ] in many studies. The remaining studies measured outcomes from self-reported data only ( n = 5) [ 50 , 54 , 67 , 69 , 95 ] or did not clearly describe the data source ( n = 17) [ 51 , 52 , 56 , 57 , 59 , 61 , 64 , 66 , 70 , 75 , 76 , 92 , 93 , 97 , 99 , 106 , 111 ]. Regarding the proportion of trauma and orthopaedic surgical patients still using opioids at follow-up, the proportion of patients using opioids at 3 months as reported in some studies varied from 12 to 30% in trauma patients [ 63 , 86 , 100 ] and from 10 to 50% in elective orthopaedic surgical patients [ 67 …”

“…This category includes ten RCTs [ 62 , 65 – 67 , 69 – 71 , 75 , 76 , 106 ], six retrospective [ 72 – 74 , 94 , 98 , 99 ] and two prospective cohort studies [ 63 , 64 ] (Table 1 : Study Characteristics, Description of Strategies and Outcomes). Most studies used a placebo ( n = 9) [ 62 , 66 , 67 , 69 , 71 , 74 – 76 , 106 ] or no intervention ( n = 7) [ 63 , 64 , 72 , 73 , 94 , 98 , 99 ] as comparators. Studies comparing the use of regional anesthesia to general anesthesia in trauma patients, showed an increase in MED at 3 months post-injury [ 98 , 99 ].…”

“…Most studies used a placebo ( n = 9) [ 62 , 66 , 67 , 69 , 71 , 74 – 76 , 106 ] or no intervention ( n = 7) [ 63 , 64 , 72 , 73 , 94 , 98 , 99 ] as comparators. Studies comparing the use of regional anesthesia to general anesthesia in trauma patients, showed an increase in MED at 3 months post-injury [ 98 , 99 ]. One study evaluating the impact of recreational cannabis use during the recovery of trauma patients showed a significant increase in MED at 6 months and in the duration of opioid use, compared to patients who never used this drug [ 63 ].…”