Perioperative Single-Shot Regional Blocks and Associated Rebound Pain-Related Unscheduled Utilization of Health Care After Distal Radius Surgery

Background: Perioperative single-shot regional blocks are commonly used for pain control in outpatient distal radius fixation surgery. While regional blocks provide initial postoperative pain control, patients often experience significant rebound pain as the block effect dissipates, which can lead to utilization of unscheduled health care (emergency department visits, phone calls, and messages sent via the electronic health record [EHR] to providers). We hypothesized that patients who received perioperative blocks are more likely to use unscheduled health care versus those who did not. Methods: A total of 619 patients underwent distal radius fracture fixation at a tertiary care academic center from 2013 to 2022. After excluding minors, inpatient and revision procedures, patients with insufficient records, and fixation of an impending pathologic fracture, 417 patients were included. Age, gender, mechanism, time to surgery, use of intraoperative local anesthetic, and whether a regional block was performed were collected. Returns to the emergency department, pain-related phone calls, and messages sent via the EHR system within 3 days of surgery were also collected. Results: The adjusted relative risk of using unscheduled health care for pain was 4.0 (95% CI, 1.3-12.1; P = .01) on postoperative day 1 for patients who received perioperative blocks compared with those who did not. Similarly, the adjusted relative risk within 2 days of surgery was 3.9 (95% CI, 1.4-10.5; P = .007) and within 3 days was 3.2 (95% CI, 1.4-7.5; P = .008). Conclusions: Patients who receive perioperative regional blocks after distal radius fixation are more likely to use unscheduled health care within the first 3 days of surgery, compared with patients who did not receive blocks.