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Anesth Analg. 2017 Sep;125(3):1014-1020. doi: 10.1213/ANE.0000000000002031.

Lack of Association Between the Use of Nerve Blockade and the Risk of Persistent Opioid Use Among Patients Undergoing Shoulder Arthroplasty: Evidence From the Marketscan Database.

Author information

1
From *Duke University, Durham, North Carolina; †Department of Anesthesiology, Hospital for Special Surgery, New York, New York; ‡Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, California; §Anesthesiology and Perioperative Care Service, Veterans Affairs, Palo Alto Health Care System, Palo Alto, California; ‖Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California; and ¶National Bureau of Economic Research, Cambridge, Massachusetts.

Abstract

BACKGROUND:

Persistent opioid use following surgery has received increasing attention from policymakers, researchers, and clinicians. Perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. We examined whether nerve blockade was associated with a decreased risk of persistent opioid use among patients undergoing shoulder arthroplasty, a procedure with high rates of persistent postoperative pain.

METHODS:

Using health care claims data, we constructed a sample of 6695 patients undergoing shoulder arthroplasty between 2002 and 2012 and used billing data to identify the utilization of nerve blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and 2 measures of opioid use: having filled at least 1 prescription for an opioid between postoperative days (PODs) 0 and 90, and between POD 91 and 365. This regression adjusted for a variety of potential confounders, such as preoperative opioid use and medical history.

RESULTS:

There was no association between nerve blockade and our 2 measures of persistent opioid use: adjusted odds ratio, 1.12 (97.5% confidence interval, 0.939-1.34; P = .15) for opioid use between POD 0 and 90, and adjusted odds ratio, 0.997 (97.5% confidence interval, 0.875-1.14; P = .95) for opioid use between POD 91 and 365.

CONCLUSIONS:

Although the use of perioperative nerve blockade may offer short-term benefits, in this study, it was not associated with a reduction in the risk of persistent opioid use for patients undergoing shoulder arthroplasty.

PMID:
28742777
DOI:
10.1213/ANE.0000000000002031
[Indexed for MEDLINE]

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