Peripheral Nerve Block Utilization is Associated With Decreased Postoperative Opioid Consumption and Shorter Length of Stay Following Total Knee Arthroplasty

Jennifer C. Wang, BS; Amit S. Piple, MD; Cory K. Mayfield, MD; Brian C. Chung, MD; Daniel A. Oakes, MD; Gligor Gucev, MD; Jay R. Lieberman, MD; Alexander B. Christ, MD; Nathanael D. Heckmann, MD

Arthroplasty Today (Apr 2023)

Peripheral Nerve Block Utilization is Associated With Decreased Postoperative Opioid Consumption and Shorter Length of Stay Following Total Knee Arthroplasty

Jennifer C. Wang, BS,
Amit S. Piple, MD,
Cory K. Mayfield, MD,
Brian C. Chung, MD,
Daniel A. Oakes, MD,
Gligor Gucev, MD,
Jay R. Lieberman, MD,
Alexander B. Christ, MD,
Nathanael D. Heckmann, MD

Affiliations

Jennifer C. Wang, BS: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Amit S. Piple, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Cory K. Mayfield, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Brian C. Chung, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Daniel A. Oakes, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Gligor Gucev, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Jay R. Lieberman, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Alexander B. Christ, MD: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
Nathanael D. Heckmann, MD: Corresponding author. Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St, Ste 2000, Los Angeles, CA 90333, USA. Tel.: +1 323 704 6363.; Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA

Journal volume & issue: Vol. 20
p. 101101

Abstract

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Background: This study aims to examine differences in postoperative complications and opioid consumption associated with perioperative peripheral nerve block (PNB) utilization during primary total knee arthroplasty (TKA). Methods: The Premier Healthcare Database was queried for adult patients who underwent primary, elective TKA from 2015 to 2020. Patients who received a femoral or adductor canal PNB were compared to patients who did not. PNB utilization was trended from 2015 to 2020. Univariate and multivariate regression analyses were performed to assess differences in the 90-day risk of postoperative complications between groups. The average inpatient opioid consumption in morphine milligram equivalents was assessed as a function of length of stay. Results: Overall, 609,991 patients were included. PNB utilization increased from 9.29% in 2015 to 30.3% in 2020. After controlling for confounders, the PNB cohort was more likely to have same-day discharge (adjusted odds ratio [aOR] 1.88) and had a decreased risk of periprosthetic joint infection (aOR 0.87), pulmonary embolism (aOR 0.81), and respiratory failure (aOR 0.78). However, there was an increased risk of seroma (aOR 1.75) and hematoma (aOR 1.22) associated with PNB utilization. Lower average overall opioid exposure was seen in the PNB cohort vs no-PNB cohort (82.1 ± 194.7 vs 89.4 ± 214.1 morphine milligram equivalents, P < .001). Conclusions: PNB utilization during primary TKA is associated with a shorter length of stay and decreased risk of multiple postoperative complications, as well as reduced postoperative opioid consumption. These data provide evidence in support of the safety and efficacy of this emerging practice. However, the clinical relevance of an increased risk of seroma and hematoma formation may warrant further investigation.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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