pain management and opioid use with long-acting peripheral nerve blocks for hand surgery: a descriptive study

Background: peripheral nerve blocks (pnbs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. peripheral nerve blocks aim to decrease overall perioperative pain and lower systemic analgesic requirements. short-acting anesthetic agents are commonly given as single-injection pnbs for pain relief, typically lasting less than 24 hours. liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection pnb and may allow patients to recover postoperatively with a lower need for opioid analgesics. objectives: this study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus pnb for hand surgery. methods: a retrospective review of patients who underwent a long-acting pnb using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between july 2020 and may 2023 in florida, usa. patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics. results: one hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the pnb to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used nsaids postoperatively. conclusions: liposomal bupivacaine pnbs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. given these results, long-acting pnbs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.