Submission
| Title: | 0.5% Bupivacaine Provides Additional Analgesia Than 0.25% Bupivacaine In Fascia Iliaca Blocks For Periacetabular Osteotomy |
| Presenter: | Amol Kular |
| Institution: | Indiana University School of Medicine |
| Authors: | Amol Kular, Indiana University School of Medicine; Yar Yeap Department of Anesthesia, Indiana University School of Medicine |
Abstract
| Background/Significance/Rationale: | Periacetabular osteotomy (PAO) is an incredibly painful surgical procedure to correct hip dysplasia resulting from a deformity in the acetabulum. Current protocols for controlling perioperative pain have no consensus and include the use of nerve blocks, lumbar epidural-based protocols, and local anesthetic wound infiltration. This study aims to gather information regarding the efficacy of 0.25% Bupivacaine vs 0.5% Bupivacaine in fascia iliaca nerve blocks. |
| Methods: | A retrospective chart review was conducted encompassing PAO patients from June 2023-June 2024. Patients were grouped according to concentration and volume of local anesthetic. Outcomes included pain scores in the post anesthesia care unit (PACU), 24-, 48-, and 72-hours post-op, duration of hospital admission and use of opioid medications. The data was sorted by concentration and volume of Bupivacaine administered. |
| Results/Findings: | Comparisons between pain scores of those receiving 0.25% and 0.5% Bupivacaine showed similar scores in the PACU and at 24 hours post-op. At 48 hours post-op, pain scores were significantly lower (p=0.052) for the 0.5% Bupivacaine group (4.52) than the 0.25% Bupivacaine group (5.21). At 72 hours post-op, pain scores were slightly lower (p=0.11) for the 0.5% Bupivacaine group (3.91) than the 0.25% Bupivacaine group (4.62). Duration of hospital admission was similar. Analyzing pain scores by volume demonstrates that 40-60 mL of Bupivacaine had lower pain scores (average=4.15, p=0.060) than those receiving 20-30 mL of Bupivacaine (average=5.22) in the PACU. Opioid usage at PACU, 24-, 48-, and 72-hour time frames showed similar milliequivalents of PO morphine needed when compared by concentration. |
| Conclusions/Discussion: | We conclude that if local anesthetic toxicity is not a problem, anesthesiologists should use 0.5% Bupivacaine 40 mL for fascia iliaca nerve blocks to provide patients with the maximum benefit from their regional anesthesia. |
| Translational/Human Health Impact: | These findings will directly alter current regimens used for PAO patients at IU Health. |
