Perceptions of Regional Anesthesia for Pediatric Supracondylar humerus fractures – a multispecialty survey

Abstract

Background The purpose of this study was to compare the prior experiences, perceived risks, benefits, complications, and practice patterns in the use of regional anesthesia for pediatric supracondylar humerus fractures between orthopaedic surgeons and anesthesiologists to better understand the attitudes and experiences governing perioperative pain management in the opioid crisis. Methods An online survey consisting of 22 multiple-choice questions regarding usage of regional anesthesia for perioperative pain management of supracondylar humerus fractures was approved by the Evidence-based Practice committee of the Pediatric Orthopaedic Society of North America (POSNA) and distributed to the active members. The same survey was also distributed to anesthesiologists associated with pediatric anesthesiology teaching centers between January 2019-June 2019. The results were captured anonymously using a RedCAP database, after which the data was exported for analysis. Results Two hundred and seventy nine physicians participated in this survey (n=249 orthopaedic surgeons [89.2%]; n=30 anesthesiologists [10.8%]). In total, 162/279 (58.1%) reported at least 10 years of practice, 236/279 (84.6%) reported practicing in an academic setting, and 185/279 (66.3%) reported a minimum volume of 20 applicable cases per year. 69.9% of Orthopaedic surgeons were moderately or highly concerned regional anesthesia would mask a compartment syndrome compared to only 10% of anesthesiologist sharing that same level of concern (p<0.001), although similar numbers of respondents treated patients with volkman’s contracture after a supracondylar humerus fracture. 76.1% of orthopaedic surgeons did not believe the level of perioperative pain warranted regional anesthesia compared to only 6.7% of anesthesiologists (p=0.005). Conclusion This multidisciplinary survey highlights the distinct differences in perceptions of regional anesthesia for supracondylar humerus fractures. These perceptional differences frame our opinions and willingness to changes our practices. This survey suggests perceptions on pain, risks, and benefits of regional anesthesia vary greatly between two major stakeholders treating the same injury.