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TOWARD OPIOID-FREE AMBULATORY SURGERY: ARE REGIONAL NERVE BLOCKS ASSOCIATED WITH IMPROVED PAIN CONTROL AND DECREASED OPIOID CONSUMPTION WHEN USED WITH A MULTIMODAL POSTOPERATIVE ANALGESIC REGIMEN IN GENERAL SURGERY?
Stefanie C. Rohde
*, Divyaam Satija, Savannah Renshaw, William T. Head, Dylan S. Goto, Sidhant Kalsotra, Peter Edwards, Kiana Shannon, Benjamin Poulose
Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
INTRODUCTION: Balancing acute pain control and risk of new persistent opioid use following surgery is a growing concern. Regional blocks have been used in non-orthopedic surgery with mixed evidence. We sought to assess the use of regional blocks in patients undergoing elective ambulatory general surgery operations.
METHODS: Elective surgery patients were prospectively recruited from a single tertiary care center from 2021-2024. Patients with immunocompromised status, preoperative chronic opioid use, and NSAID or acetaminophen allergy/intolerance were excluded. The "Toward Opioid-Free Ambulatory Surgery" postoperative analgesic regimen (alternating scheduled ibuprofen and acetaminophen with rescue oxycodone), developed through engagement with 22 surgeons, was prescribed on discharge. Pre/postoperative surveys assessed patient-reported factors and opioid use. To compare patients who did and did not receive intraoperative regional blocks (e.g., transversus abdominis plane or ilioinguinal/iliohypogastric), 1:1 propensity score matching was performed using logistic regression to balance preoperative patient-reported history of chronic pain, history of prior opioid use, non-opioid analgesic use, belief that opioids are addictive, and pain intensity; anesthesia type; and patient age. Unadjusted and adjusted groups were compared using chi-square and Mann-Whitney U tests.
RESULTS: 223 patients were enrolled. Median age was 50 years (IQR 23.5, range 19-91). Most were male (69%) and white (91%). Preoperatively, 25% reported chronic pain, 9% reported prior opioid use, and 67% reported non-opioid analgesic use; 91% believed opioids to be addictive; and 53% reported low preoperative pain intensity. Nearly all underwent general anesthesia (100% who received a regional block and 95% who didn’t). Inguinofemoral hernia repair was the most common operation (53%), followed by epigastric, umbilical, or incisional hernia repair (27%), laparoscopic cholecystectomy (17%), and skin lesion excision (2%). Of the 195 patients without missing regional block data, 37% received a regional block (64% of inguinofemoral hernia repairs, 24% of anterior abdominal hernia repairs, 0% of cholecystectomies or skin lesion excisions). 43% filled their opioid prescription and used a median of 4 (IQR 2-8) of 10 prescribed doses. After matching, standardized mean differences for all covariates were <0.10, indicating good balance. In the matched cohort, there were no statistically significant differences between the regional block and comparator groups’ use of a rescue opioid prescription, nor the doses used; results were unchanged after restricting to hernia repairs alone (Table).
CONCLUSION: Regional blocks, when used in addition to a standardized multimodal post-discharge analgesic regimen, were not significantly associated with reduced opioid consumption in a propensity score matched cohort.
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