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General vs. Regional Anesthesia in Cubital Tunnel Release: Differences in Surgical Complications and Opioid Use
Majd Mzeihem, MD, John Alvarez, B.S., Michael Foy, MD, Diego Barragan, MD, Alfonso Mejia, MD, MPH; Mark Gonzalez, MD, PhD
University of Illinois at Chicago, Chicago, IL
Introduction:This study evaluates whether patients undergoing cubital tunnel release with general anesthesia have different rates of revision, surgical complications, and opioid prescriptions compared to those treated with regional anesthesia techniques.
Methods:Patients with unilateral cubital tunnel syndrome were identified in the PearlDiver Mariner database (2010-2022) using ICD-9/10 codes. Those who underwent cubital tunnel release (CUTR) were grouped as general anesthesia (GA) or regional anesthesia (RGA) based on anesthesia codes and documentation. Primary outcomes were ipsilateral CUTR revision, 90-Days surgical complications (infection, wound dehiscence), and opioid use. Patients were matched by age, gender, CCI, diabetes, and hypothyroidism. Independent t-tests, chi-square tests, and multivariate logistic regression were used, with significance at P < .05.
Results:A total of 15,914 patients were included, with 7,957 patients each in the GA and RGA groups. Rates of seroma, hematoma, infection, wound dehiscence, surgical complications, wound complications, and opioid abuse were similar between groups (all
P > 0.05). Revision surgery was significantly more common in the RA group compared to GA (3.93% vs. 3.09%; OR 1.29, 95% CI 1.08-1.52;
P = 0.004). Patients receiving RA were also more likely to receive oxycodone (22.80% vs. 21.39%; OR 1.09, 95% CI 1.01-1.17;
P = 0.03) and any opioid prescription overall (61.45% vs. 59.70%; OR 1.07, 95% CI 1.01-1.15;
P = 0.02). No significant differences were found for ulnar nerve injury, complex regional pain syndrome, or hydrocodone and other opioid prescriptions (Table 1).
Conclusion:In this matched cohort, regional anesthesia was associated with a significantly higher revision rate and increased opioid use compared to general anesthesia, despite similar rates of surgical and wound complications. These findings suggest that while RA may offer intraoperative benefits, its impact on longer-term outcomes and pain management warrants further investigation. Surgeons and anesthesiologists should carefully weigh the potential for increased revision risk and postoperative opioid demand when selecting anesthesia type for these patients. Prospective studies are needed to clarify whether patient selection, surgical factors, or perioperative protocols contribute to these differences.
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