Introduction A large body of literature suggests that peripheral nerve blockade (PNB) is associated with improved perioperative outcomes in total hip and knee joint arthroplasty patients. However, it is unclear to what extent this association exists across patient subgroups based on age and health status.
Methods Patients who underwent total joint arthroplasty were identified from the Premier Healthcare database (2006–2019). Mixed-effects models were applied to assess the relationship between exposure of interest (PNB use on the day of surgery) and various outcomes (postoperative respiratory complications, acute renal failure, delirium, intensive care unit admission, prolonged length of stay, and high opioid consumption) across multiple subgroups stratified by patient age and pre-existing comorbidities.
Results PNB use and outcome association varies based on the patient’s health and age characteristics. For adults and older adults with excellent or fair, there was a decrease in the likelihood of respiratory complication with the use of PNB (OR: 0.92, 95% CI 0.86 to 0.98; OR: 0.88, 95% CI 0.81 to 0.95; OR: 0.94, 95% CI 0.89 to 0.99, respectively). Peripheral nerve blocks were also associated with a reduction in the odds of high opioid consumption across all categories except adult patients in poor health.
Conclusion PNB use is associated with beneficial effects more commonly observed among patients with a lower comorbidity burden, without a clear pattern of association with patient age.
- Pain Management
- REGIONAL ANESTHESIA
Data availability statement
Data may be obtained from a third party and are not publicly available. Data was obtained from a third party (Premier Inc) and are not publicly available.
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Contributors SGM, CC, JL, and JP have helped design the study, conduct the study, analyze the data, and write the manuscript and have approved the final manuscript. HZ and AI have performed the statistical analysis, helped conduct the study, and write the manuscript and have approved the final manuscript. VA have helped conduct the study, analyze the data and write the manuscript and have approved the final manuscript. SGM and JL accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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