Regional Anesthesia and Long-Term Opioid Use Following Total Knee or Hip
Arthroplasty in a Military Treatment Facility
Kalyn Jannace, MPH, PhD Candidate3,4; Matthew Millington3,4; George Figueroa3,4; Nicholas Giordano, PhD3,4; Krista Highland, PhD2,3,4; Chester Buckenmaier III, MD2,3,; Michael Kent, MD1 ;
1Department of Anesthesiology, Duke University; Durham, NC; 2Uniformed Services University of the Health Sciences; Bethesda, MD
3Defense and Veterans Center for Integrative Pain Management; Rockville, MD, 4Henry M. Jackson Foundation for the Advancement of Military Medicine; Bethesda, MD
•As part of a multimodal analgesic pathway, patients undergoing total knee or total hip arthroplasty (TKA/THA) may receive regional anesthetic techniques and non-opioid adjuncts (e.g., gabapentin) in order to minimize the use of opioids post-surgery.
•The preventative role of perineural blockade in regards to persistent post-surgical opioid use has been questioned in patients undergoing TKA/THA.1
•The goal of the present study was to examine the relationship between perineural blockade (PNB) and opioid use 3-months post-surgery.
•Participants undergoing TKA/THA (N=205) at a military treatment facility completed the Defense and Veterans Pain Rating Scale (DVPRS), which assessed average past 24-hour pain intensity within the context of functioning, and a single item assessing current opioid use (no or yes). Assessment occurred pre-surgery (baseline) and 3-months post-surgery.
•TKA patients received single injection adductor canal blocks and THA patients received fascia iliaca blocks.
•Demographic and PNB data was extracted from the electronic health record.
•The R package bestglm determined covariates for in a generalized linear regression model (GLM) predicting follow-up opioid utilization
•Potential covariates included: age, body mass index, sex, smoking status, military status, baseline opioid use, PNB, number of non-opioid analgesia adjuncts administered during surgery, and 3-month DVPRS past 24-hour pain intensity.
•Baseline opioid use, PNB, and 3-month DVPRS scores accounted for 25% of follow-up opioid use.
•Those who received a PNB were, on average, 10% less likely to report using an opioid at 3-month post-surgery than those who did not receive a PNB (12% vs. 2%).
•The probability of 3-month follow-up opioid use was highest for those who did not receive a PNB and used opioids at baseline, but lowest for those who received a PNB and did not use opioids at baseline.
•When used as part of a multimodal analgesia pathway, PNB was associated with lower risk of opioid use 3-months after TKA/THA.
•Age, body mass index, sex, smoking status, military status, and number of non-opioids administered did not significantly contribute to the model.
•Given PNB, baseline opioid use, and 3-month pain intensity accounted for 25% of 3-month opioid use, research is needed to identify additional modifiable factors that account for long-term opioid use after TKA/THA in the Military Health System.