Increased use of PNBs in hip and knee arthroplasty could improve medical outcomes

The use of peripheral nerve blocks (PNBs) is associated with better medical and economic outcomes in patients receiving hip and knee replacement, according to research being presented at the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting later this month.

An estimated 1 million people undergo hip or knee replacement each year in the United States. Patients may be kept awake during the procedure using neuraxial anesthesia, which is associated with fewer complications than general anesthesia, in which the patient is put to sleep.

Peripheral nerve blocks are often added in order to reduce pain and need for systemically active pain medications such as opioids. PNBs involve injecting medication around specific nerves that supply the areas of surgery. The use of PNBs is on the rise but still not used routinely in hip and knee arthroplasty. In the study, about 18% of patients had received PNBs.

A team of researchers looked at more than 1 million cases of hip and knee arthroplasty over a 7-year period. They compared the rate of complications such as heart attack; lung, gastrointestinal, and kidney complications; stroke; infection; wounds; clots; inpatient falls; and mortality in those receiving a PNB to those without the intervention. They also looked at resource utilization such as the need for blood transfusion, admission to intensive care, opioid consumption, length of stay, and cost of hospitalization.

In terms of both complications and resource utilization, PNBs were associated with better outcomes than when the intervention was not used irrespective of anesthesia type chosen. The researchers concluded that increased use of PNBs in patients receiving knee and hip reconstruction and replacement could have a significantly positive impact on medical and economic outcomes.