Patel Akshar H, Ross Bailey J, Ofa Sione A, Flick Travis R, Sanchez Fernando L, Sherman William F
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Arthroplast Today. 2020 Nov 21;6(4):1016-1021.e9. doi: 10.1016/j.artd.2020.10.001. eCollection 2020 Dec.
The impact of femoral nerve blocks (FNBs) during primary total knee arthroplasty (TKA) on clinical outcomes and pain management remains unclear. The present research investigates the impact that continuous and single-shot FNBs during TKA have on postoperative opioid claims and short-term clinical outcomes.
An administrative claims database was queried to identify patients who underwent primary TKA with a continuous FNB, single-shot FNB, or no FNB. More than 300,000 patients were analyzed from the database. Rates of opioid claims were compared via achi-square analysis. Incidence of postoperative complications was compared with multivariable logistic regression.
Patients receiving a FNB had a significantly higher risk of falls both at 6 months (odds ratio [OR], 1.30) and 1 year postoperatively (OR, 1.25), as well as readmissions within 90 days (OR, 1.18) compared with patients without FNBs. The FNB cohort exhibited a higher risk of deep vein thrombosis (OR, 1.57), myocardial infarction (OR, 1.79), and cerebrovascular accident (OR, 1.20) during the inpatient stay. Relative to single-shot FNBs, continuous FNBs were associated with a higher risk of readmissions within 90 days and systemic complications, although the risk varied by age, sex, and Charlson Comorbidity Index score. More patients without FNBs filed opioid claims within 1 year postoperatively, but the average total morphine milligram equivalents prescribed was comparable to patients who received FNBs.
FNBs during TKA place patients at a significantly higher risk of falls, readmissions, and systemic complications in the short term. The risk of readmission and systemic complications was higher for continuous FNBs. More patients without FNBs filed opioid claims postoperatively than patients who received FNBs.
在初次全膝关节置换术（TKA）中，股神经阻滞（FNBs）对临床结局和疼痛管理的影响尚不清楚。本研究调查了TKA期间连续和单次FNBs对术后阿片类药物使用情况和短期临床结局的影响。
查询一个管理索赔数据库，以识别接受连续FNB、单次FNB或未接受FNB的初次TKA患者。对数据库中的30多万名患者进行了分析。通过卡方分析比较阿片类药物使用索赔率。采用多变量逻辑回归比较术后并发症的发生率。
与未接受FNBs的患者相比，接受FNBs的患者在术后6个月（优势比[OR]，1.30）和1年（OR，1.25）跌倒的风险显著更高，以及90天内再次入院的风险（OR，1.18）。FNB组在住院期间发生深静脉血栓形成（OR，1.57）、心肌梗死（OR，1.79）和脑血管意外（OR，1.20）的风险更高。相对于单次FNBs，连续FNBs与90天内再次入院和全身并发症的风险更高相关，尽管风险因年龄、性别和Charlson合并症指数评分而异。更多未接受FNBs的患者在术后1年内提出阿片类药物使用索赔，但开具的吗啡毫克当量总量平均值与接受FNBs的患者相当。
TKA期间的FNBs使患者在短期内跌倒、再次入院和全身并发症的风险显著更高。连续FNBs的再次入院和全身并发症风险更高。术后提出阿片类药物使用索赔的未接受FNBs的患者比接受FNBs的患者更多。
