The Opioid-Sparing Benefits of Regional Anesthesia With Sedation in Pediatric Orthopedic Surgery: A Retrospective Analysis

TL;DR

Using regional anesthesia with sedation in pediatric orthopedic surgery reduces opioid use and improves early recovery compared to general anesthesia.

Contribution

This study provides empirical evidence that regional anesthesia with sedation reduces opioid consumption in pediatric orthopedic surgery.

Findings

RA significantly reduced intraoperative opioid use compared to GA and GA+RA.

RA improved early postoperative pain control with more frequent FLACC scores of 0.

PACU opioid use was lower in RA and GA+RA groups compared to GA.

Abstract

Introduction

Regional anesthesia may reduce perioperative opioid exposure in pediatric orthopedic surgery; however, comparative data with general or combined anesthesia remain limited. This study evaluated the association between regional anesthesia with sedation (RA) and perioperative opioid consumption, as well as its relationship with early recovery outcomes, compared to general or combined anesthesia.

Methods

We performed a retrospective cohort study of 191 pediatric patients (0-18 years) who underwent single-limb orthopedic surgery between 2019 and 2022 at Kaplan Medical Center. Patients were stratified by anesthetic technique: general anesthesia (GA, n = 130), combined general and regional anesthesia (GA+RA, n = 32), and RA (n = 29). The primary outcome was intraoperative opioid consumption, expressed as morphine equivalent dose (MED) per kg. Secondary outcomes included postoperative opioid use in the post-anesthesia care unit (PACU) and ward, Face, Legs, Activity, Cry, Consolability (FLACC) pain scores, postoperative nausea and vomiting (PONV), PACU length of stay, and total hospital stay.

Results

Median intraoperative opioid use was significantly lower in the RA group (0.16, IQR 0.11-0.20) than in the GA+RA (0.26, IQR 0.18-0.32) and GA groups (0.30, IQR 0.16-0.38) (p < 0.001). PACU opioid consumption was also reduced in the RA and GA+RA groups (0.01 MED/kg each) compared to the GA group (0.03 MED/kg; p = 0.001). A FLACC score of 0 in the PACU was more frequent in the RA group (72.4%) than in the GA+RA (62.5%) and GA (47.7%) groups (p = 0.042). The incidence of PONV was lowest in the RA group (3.4%), although the difference was not statistically significant (p = 0.365).

Conclusions

RA was associated with significantly lower intraoperative and immediate postoperative opioid requirements and improved early pain control compared with GA. These findings support the broader adoption of sedation-assisted regional anesthesia as an opioid-sparing strategy in pediatric orthopedic surgery.

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