OBJECTIVES: To evaluate the effect of peripheral nerve blocks (PNB) on postoperative opioid use, length of stay (LOS), and incidence of acute compartment syndrome (ACS) in patients presenting with acute tibial shaft fractures treated with intramedullary nail (IMN) fixation.
METHODS: Design: Retrospective cohort study Setting: Level 1 Academic Trauma Center from 2018 to 2022. Patient Selection Criteria: Patients aged 18-79 years with acute AO/OTA 42A-C tibial shaft fractures treated with IMN within 7 days of injury Outcome Measures and Comparisons: The primary outcome was postoperative opioid use, measured in morphine milligram equivalents (MME), during hospital stay, up to a maximum of 72 h after surgery. Patients who received a preoperative PNB were compared to those who did not receive a block. Secondary outcomes included postoperative LOS and incidence of ACS.
RESULTS: 246 patients were eligible for analysis of which 78 (32%) received a PNB (PNB=yes) and 168 (68%) did not (PNB=no). Mean MME were significantly lower in the PNB=yes group compared to the PNB=no group at 24 h (73 vs. 138, p < 0.001). Controlling for age, Injury Severity Score (ISS), and time to surgery, a multivariable regression model demonstrated a 36% reduction in MME per hour for patients that received PNBs. There were 3 cases of ACS in PNB=No and 1 in PNB=Yes. All 3 patients without a PNB were diagnosed within 2 days of surgery and underwent uncomplicated fasciotomies. One patient with a PNB re-presented to the hospital 5 days postoperatively, underwent fasciotomies, and was found to have anterior and lateral compartment necrosis.
CONCLUSION: PNBs for select acute tibial shaft fractures treated with IMN were associated with decreased opioid requirements in the first 24 h after surgery. No effect was noted beyond 24 h after surgery. Extreme vigilance is essential in patients with tibia fractures to monitor for ACS, especially when PNB is utilized.
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