Does regional anesthesia impact the frequency and timing of fasciotomy following surgical repair of lower leg fracture; A National Database Analysis

There is controversy surrounding the use of regional anesthesia for the surgical repair of tibia and/or fibula fractures. In this study our goals are 1.) to describe the utilization of regional anesthesia for repair of lower leg fractures using a large nationally representative database; 2.) to compare the incidence of acute compartment syndrome (ACS) and need for fasciotomy following lower leg fracture surgery between patients who received nerve blocks and those that do not; 3.) compare the timing of postoperative fasciotomy between patients that received nerve blocks and those that do not. Retrospective study of national administrative database. The population of interest were patients who underwent surgery for repair of tibia and fibula fractures and subsequent fasciotomy from the Premier Healthcare database (Premier Healthcare Solutions, Inc., Charlotte, NC; 2006–2021. Surgical repair of tibia and fibula fractures as well as fasciotomies were identified using a standard set of international classification of diseases -ninth/tenth revision (ICD-9/10) codes. None. The Primary outcome was incidence of lower leg fasciotomy and/or compartment syndrome diagnoses following lower leg fracture repair surgery. We compared patients who received nerve blocks with those that did not receive nerve blocks. As a secondary outcome we compared the timing of fasciotomy after the index surgery between patients who received nerve block and those that did not receive a nerve block. Our study population included 77,685 patients who underwent surgery for a tibia and/or fibula fracture, of which 5241 (6.7 %) patients had a nerve block. Overall, 3009 (3.9 %) of patients received an ACS diagnosis and 2448 (3.2 %) underwent a fasciotomy. Patients who did not receive a nerve block were more likely to receive a diagnosis of ACS ( n = 2889), 4.0 % no block vs. n = 120, 2.3 % block p < 0.0001). Fasciotomies were performed more frequently in patients who did not receive a nerve block compared to those that did ( n = 2359, 3.3 % no block vs. n = 89, 1.7 % p < 0.0001). The mean day of fasciotomy for patients who did not receive nerve blocks was 1.5 with 4.0 in patients who received nerve blocks ( p < 0.001). Nerve blocks are not widely used for postoperative analgesia following lower leg fracture surgery. The population of patients who receive nerve blocks is different than patients who do not receive nerve blocks. Nerve blocks were not associated with an increase in ACS diagnosis or fasciotomy. • In a national database, the use of nerve blocks for lower limb fracture surgery was rare. • The patients who received nerve blocks were significantly different than those that did not receive nerve blocks. • Nerve blocks were not associated with an increased incidence of ACS or fasciotomy following lower leg fracture surgery.