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Regional anesthesia for nonunion surgery with iliac crest bone grafting results in an increase in same day discharge

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to evaluate the outcomes of fracture nonunion repair with autogenous iliac crest bone graft (ICBG) under regional anesthesia alone or in combination with other techniques compared to other anesthesia techniques.

Materials and methods

Overall, 137 patients were identified who underwent ICBG as part of a repair of a long bone fracture nonunion between January 1, 2013 and October 1, 2020. Surgical and anesthetic records were reviewed to classify patients by anesthesia type. General, spinal, and regional anesthetics were used as either the primary anesthetic or as a combination of regional nerve block with general or spinal anesthesia.

Results

Administration of regional anesthesia alone or in combination with general or spinal anesthesia (RA) and general or spinal anesthesia only (GS) groups differed in nonunion site distribution (p < 0.001). RA patients were discharged the same day more often than GS patients (30.9% vs 10.0%, p = 0.009) and experienced fewer postoperative complications (p = 0.021). The RA group achieved union sooner than the GS group (by 5.3 ± 3.2 months vs. by 6.8 ± 3.2 months, p = 0.006). Mean morphine equivalent dose was similar between groups (p = 0.23). Regional anesthesia use increased from 2013 to 2020, and same day discharge surgeries simultaneously increased over the same time period.

Conclusion

Regional anesthesia use increased in nonunion repair surgery with ICBG from 2013 to 2020. This was associated with an increase in same day discharge, sooner time to union, and decreased postoperative complications. There was not a need for increased opioid prescription in patients that underwent regional anesthesia.

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Funding

There was no source of funding for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA

    Connor P. Littlefield, Rown Parola, David Furgiuele, Sanjit Konda & Kenneth A. Egol

Authors
  1. Connor P. Littlefield
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  2. Rown Parola
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  3. David Furgiuele
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  4. Sanjit Konda
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  5. Kenneth A. Egol
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Contributions

KE, SK, and DF contributed to the study conception and design, and manuscript revising. Material preparation, data collection and analysis, and initial manuscript drafting were performed by RP and CL. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenneth A. Egol.

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Conflict of interest

Non-related conflicts of interest for Sanjit Konda, MD include paid consultant for Stryker. Non-related conflicts of interest for Kenneth Egol, MD include committee member of the Orthopaedic Trauma Association, a paid consultant for Exactech, and receives research support or publishing royalties from Acumed, Synthes, SLACK Incorporated, and Lippincott Williams & Wilkins. The remaining authors declare that they have no conflict of interest related to this study.

Ethical approval

This study was approved by the NYU School of Medicine Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Littlefield, C.P., Parola, R., Furgiuele, D. et al. Regional anesthesia for nonunion surgery with iliac crest bone grafting results in an increase in same day discharge. Eur J Orthop Surg Traumatol 32, 1187–1193 (2022). https://doi.org/10.1007/s00590-021-03097-8

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  • DOI: https://doi.org/10.1007/s00590-021-03097-8

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