Orthopaedic Traumatologist Preference for Use of Regional Anesthesia in Fracture Management. A Survey of OTA Members.
Abstract Title: ORTHOPAEDIC TRAUMATOLOGIST PREFERENCE FOR USE OF REGIONAL ANESTHESIA IN FRACTURE MANAGEMENT. A SURVEY OF OTA MEMBERS. Abstract ID: 246 Abstract Category: Clinical Research Introduction: Regional anesthesia (RA) is becoming more prevalent and mainstream as part of pain management protocols following operative procedures. Previous studies have documented the many advantages of its use including improved pain control, decreased opioid consumption, and shorter stays in the recovery room as well as the hospital.The specific use of RA in fracture care is controversial and the clinical decision as to which patients should receive this pain management technique is unclear. Often, orthopaedic trauma patients have evolving soft tissue injuries at the time of surgical intervention and therefore post-operative neurovascular function may need to be closely monitored. The question then arises; which patients with fractures can benefit from regional anesthesia while not putting the soft tissues at risk for adverse events such as compartment syndrome? Purpose:To identify orthopaedic traumatologist preference for use of RA in fracture care. A secondary objective is to determine the prevalence of morbidity derived from regional anesthesia use in the trauma population. Methods: A prospective electronic survey was designed and a link placed on the Orthopaedic Trauma Association (OTA) website. OTA members went through thirteen clinical scenarios involving lower extremity injuries that detailed patient age, mechanism of injury, and fracture pattern. Based on the clinical scenario, surveyors were given options of using regional anesthesia as part of the pain management plan or forgoing its use. If regional anesthesia was selected for the given clinical scenario, participants then chose between the use of spinal anesthesia, one shot peripheral nerve injection, or continuous nerve catheter infusion. For the last portion of the survey, surveyors were asked to complete questions pertaining to their clinical experience with regional anesthesia masking compartment syndrome or leading to increased patient morbidity due to a delayed diagnosis. Results: Over 90% of OTA members viewed a high energy tibial plateau or tibial shaft fracture as a contraindication to any form of regional anesthesia. Preference for use of RA in other lower extremity fracture patterns varied significantly. Over 60% of respondents have seen the use of RA delay or mask the diagnosis of compartment syndrome resulting in patient morbidity. Conclusion: The majority of OTA members viewed high energy tibial plateau and shaft fractures as contraindications to the use of regional anesthesia. The results have clinical as well as medico-legal implications in patient care and necessitates teamwork between anesthesiologists and orthopaedic surgeons appropriately risk stratify which patients can safely be administered RA.