Analgesic Efficacy of Multiple Single-Shot Peripheral Nerve Blocks on Postoperative Short-Term Opioid Usage and Clinical Outcomes in a Suburban Hospital Setting

Abstract

Background: Preoperative single-shot peripheral nerve blocks (sPNBs) represent promising candidates for controlling postoperative pain, reducing dependence on opioid medications, and reducing postoperative constipation and ileus. However, there is not yet complete consensus regarding their efficacy. The primary aim of this study was to assess the impact of various sPNBs on patient short-term opioid demands and pain management parameters.

Methods: This single-center study retrospectively reviewed a cohort of 94 adult, elective surgery inpatients (ASA physical status I-III) scheduled for different operations. Sixty-four (68.1%) were selected for sPNB administration (group 1) and compared to the untreated group (group 0) for different clinical parameters.

Results: Contrary to the starting hypothesis, a higher proportion of group 1 patients experienced increasing pain intensities during the immediate postoperative period (P < 0.05, Fisher's exact test), while requiring more bowel care medications (P < 0.05, χ² test). Multiple linear regression modeling, however, showed that recovery time positively correlated with the opioid amount consumed (P < 0.01). Although limited, the results obtained in this study do not support an analgesic efficacy for sPNBs.

Conclusion: In conclusion, even though our data must be viewed within the limitations of our retrospective study and small group size, we did not find any compelling evidence for the efficacy of sPNB administration in the perioperative period.

Keywords: Opioid; Pain management; Postoperative recovery; Single-shot peripheral nerve block.

Figure 1

Box plots illustrating the results of the Mann-Whitney U-tests performed on four relevant quantitative variables for the between-group comparison: (a) total consumption of opioids (MME), (b) pain onset time, (c) pain rate reported (1 - 10), and (d) satisfaction with pain management (1 - 10). All tests are non-significant. In-box partitions represent means. Square dots represent medians. Box edges represent 25th and 75th percentiles. Whiskers represent 5th and 95th percentiles. Round dots represent outlying values. P < 0.05.

Figure 2

Bar plots illustrating the between-group comparisons concerning (a) pain perception, (b) bowel care received, (c) requesting opioids, and (d) received opioids variables. I: increased; D: decreased; =: constant (P = 0.011, Fisher’s exact test); Y: yes, N: no (P < 0.001, χ² test). P < 0.05.