Peripheral Nerve Block Use in Ankle Arthroplasty and Ankle Arthrodesis: Utilization Patterns and Impact on Outcomes

Abstract

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthrodesis (AA) and total ankle arthroplasty (TAA) are often associated with significant postoperative pain; this may be mitigated by the use of peripheral nerve blocks (PNB). While smaller studies suggest PNB to be an effective pain management option in foot and ankle procedures, large scale comparative effectiveness data in ankle arthrodesis and TAA is lacking. Therefore, the purpose of this national study was to evaluate PNB utilization patterns and its impact on outcomes such as opioid utilization. Methods: This retrospective cohort study utilized data from the nationwide Premier Perspective claims database (2006-2016) on AA (n=10,049) and TAA (n=4,977) procedures. Mixed-effects models estimated associations between PNB use (defined from inpatient billing) and opioid utilization (during the total hospitalization period and specified by each day), hospitalization costs, length of stay (LOS), admission to skilled nurse facility (SNF), opioid-related complications, and 90-day readmission. We report odds ratios (OR, or % change for continuous outcomes) and 95% confidence intervals (CI). Results: Overall, PNB was utilized in 8.6% of TAA and 8.5% of AA. Both procedures demonstrate increased utilization of PNB from 2006 to 2016 (2.7% to 11.7% and 5.5% to 11.7% for TAA and AA, respectively). In general, PNBs were utilized less in non- teaching and smaller hospitals and among surgeries performed by a podiatrist (compared to orthopaedic surgeon). After adjustment for relevant covariates, PNB use was significantly associated with decreased opioid utilization during the total hospitalization period for both TAA (-15.7%, CI 22.8; 7.9%) and AA (-16.0%, CI 21.9%; 9.7%); this was particularly driven by a decrease in opioid utilization on the day of surgery. PNB use was not associated with reductions in LOS, cost of hospitalization, discharge to SNF, complications, 90-day readmission. Conclusion: In this first national study on PNB use in ankle procedures we found an overall low use of PNB while an increasing trend in utilization was observed. Importantly, PNB use was associated with significant opioid-sparing effects (especially on the day of surgery), while no effects were seen for other outcomes. Given the current low utilization rate, increased use of this analgesic technique may translate into more benefits in terms of clinical outcomes and resource utilization.