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American Association for Hand Surgery

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Pain Control and Satisfaction with Peripheral Nerve Blocks for Upper Extremity Surgery
Caroline M. Wu, BS1, Kristin E. Karim, MD2, Cyril S. Gary, MD1, Kavya K Sanghavi, MPH1, Michael S. Murphy, MD3, Jeffrey T. Hobelmann, MD4 and Aviram M Giladi, MD, MS1, (1)The Curtis National Hand Center, Baltimore, MD, (2)Curtis National Hand Center, Baltimore, MD, (3)Curtis National Hand Center, The Curtis National Hand Center, Baltimore, MD, (4)US Anesthesia Partners, Maryland Platform, Baltimore, MD

Introduction:
Regional block anesthesia ("block") is an increasingly important component of upper extremity (UE) surgery pain control. However, little is known about the patient experience, especially as related to perioperative opioid use. This study evaluated overall satisfaction and reported pain outcomes after blocks for UE surgery.

Materials and Methods:
Patients who underwent anesthesiologist-administered supraclavicular nerve blocks prior to UE surgery at a single outpatient surgery center from 2018 to 2020 and completed a phone questionnaire 24-72 hours post-operatively were included. Survey questions included block duration, whether opioid pain medication was consumed before and after the block wore off, self-reported pain scores at the time of the block wearing off ("initial") and at time of phone interview ("final"), and satisfaction with block duration. Mann-Whitney U and Fisher's Exact Tests were used to compare patient-reported outcomes between patients who consumed and those who did not consume opioids prior to the block losing effectiveness. Bivariate and multivariable linear regression was used to examine associations with initial pain scores and bivariate and multivariable ordered logistic regression was used to examine associations with satisfaction levels.

Results:
509 patients completed the questionnaire. 61% underwent bone/joint procedures. Median block duration was 12 hours (IQR, 10-15). 88% were satisfied or very satisfied with block duration. 22% took opioids before the block wore off. Initial pain scores and final pain scores were significantly higher in patients who took opioids prior to the block wearing off (6 and 4.5, p= 0.04 and 3.5 and 2, p= 0.002). Satisfaction with block duration was not significantly different between the two groups (4 and 4, respectively; p= 0.47). Premedicating with opioids prior to the block wearing off was associated with increased odds of reporting higher satisfaction compared to patients who did not premedicate (OR 1.78, p= 0.03). Controlling for other covariates, taking opioids prior to the block wearing off was associated with higher initial pain scores (Table 1).

Conclusion:
Most patients were satisfied with the duration of the block. Patients who premedicated reported higher satisfaction with the block; however, patients who premedicated also reported higher pain scores even with the premedication. Our findings highlight the value of multi-modal analgesia in pain management, but call into question the common practice of pre-medicating with opioids prior to block losing effectiveness.


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