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

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.

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.

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'.

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.