Influence of single shot and continuous peripheral nerve block on opioid consumption and perioperative pain management in patients undergoing total elbow arthroplasty

Tamara Babasiz, MD; Michael Hackl, MD, PhD; Sebastian Wegmann, MD; Jan Hockmann, MD; Kai Hoffeld, MD; Lars P. Müller, MD, PhD; Tim Leschinger, MD, PhD

doi:10.1016/j.jseint.2025.03.003

JSES International (Jul 2025)

Influence of single shot and continuous peripheral nerve block on opioid consumption and perioperative pain management in patients undergoing total elbow arthroplasty

Tamara Babasiz, MD,
Michael Hackl, MD, PhD,
Sebastian Wegmann, MD,
Jan Hockmann, MD,
Kai Hoffeld, MD,
Lars P. Müller, MD, PhD,
Tim Leschinger, MD, PhD

Affiliations

Tamara Babasiz, MD: Corresponding author: Tamara Babasiz, MD, Department for Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, Cologne 50937, Germany.; Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Michael Hackl, MD, PhD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Sebastian Wegmann, MD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Jan Hockmann, MD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Kai Hoffeld, MD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Lars P. Müller, MD, PhD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany
Tim Leschinger, MD, PhD: Faculty of Medicine and University Hospital Cologne, Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany

DOI: https://doi.org/10.1016/j.jseint.2025.03.003
Journal volume & issue: Vol. 9, no. 4
pp. 1251 – 1256

Abstract

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Background: Peripheral nerve block (PNB) is effective for pain management after shoulder arthroplasty. Our study investigated the impact of regional anesthesia on perioperative pain management following total elbow arthroplasty (TEA). We aimed to determine whether single shot anesthesia (SSA) or continuous peripheral nerve block (CPNB) reduces opioid usage and improves postoperative pain levels compared to general anesthesia alone. Methods: A retrospective analysis evaluated 78 patients who underwent TEA for perioperative pain management, including nonopioid, opioid medications, and on-demand opioid use. Postoperative pain was assessed using the Numeric Rating Scale (NRS). Patients were divided into 3 groups based on anesthesia type: Group 1 received a PNB intraoperatively and a CPNB; Group 2 received SSA; and Group 3 underwent general anesthesia alone. Pain management and perception were compared over 5 days postoperatively using the Mann-Whitney U test. Results: Group 1 had significantly lower intraoperative opioid usage compared to group 3 (P = .0423) and required fewer opioids postoperatively (P = .0114). Group 1 also reported lower NRS scores, indicating better pain relief (P < .0001). Group 2 showed a trend toward reduced intraoperative (P = .4372) and postoperative opioid (P = .1107) use compared to group 3, although with no statistical significance. Group 2 had significantly lower NRS scores than group 3 (P = .0023). Conclusion: In this first study on PNB and CPNB in TEA, we showed that CPNB reduces perioperative opioid use and improves postoperative pain. SSA offers no significant advantage over CPNB in reducing opioid usage. Avoiding systemic opioids and their adverse effects is particularly beneficial for elderly patients.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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