Impact of peripheral nerve blocks on chronic opioid use after elective total knee arthroplasty from a large US claims database.

Overview

abstract

BACKGROUND: Peripheral nerve blocks (PNBs), either single-shot injection or continuous catheter infusion, are increasingly used in total knee arthroplasties (TKAs). Although recent data show equivalence between both modalities in immediate perioperative analgesia, comparative data on longer-term outcomes such as chronic opioid use are scarce. METHODS: Using US Merative MarketScan commercial claims data (2018-22; n=126 860 TKAs), we compared: (1) patients receiving PNB vs those who did not; and (2) single-shot vs continuous catheter infusion PNB. Primary outcomes were: (1) 'chronic opioid dependence' (>120 pills of opioids prescribed or >10 prescriptions between postoperative day 90 and 180); and (2) 'chronic opioid use' (any opioid refill between postoperative day 90 and 180). Multivariable models measured associations between PNB modalities and outcomes. RESULTS: Incidence of 'chronic opioid dependence' was 0.7%, 0.8%, and 0.9% among patients without PNB, with single-shot PNB, and with continuous PNB, respectively. For 'chronic opioid use', this was 12.6%, 13.8%, and 14.3%. Multivariable analyses indicated no association between PNB (yes/no and modality) utilisation and 'chronic opioid dependence'. However, single-shot (OR 1.01, 95% CI 1.01-1.02; P<0.001) and continuous PNB (OR 1.01, 95% CI 1.01-1.02; P<0.001) compared with no PNB use were associated with slightly higher odds of 'chronic opioid use'. DISCUSSION: Our results did not show any clinically meaningful differences in postoperative chronic opioid use or dependence across patients receiving single-shot PNB or continuous PNB treatment. Future prospective registry data might be indicated to further address this question.