外周神经阻滞可减少全髋关节置换术后的早期医疗并发症、脱位和阿片类药物用量。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2025-02-01 DOI:10.1016/j.artd.2024.101587

Brian P. McCormick MD, Sean B. Sequeira MD, Mark D. Hasenauer MD, Robert P. McKinstry MD, Frank R. Ebert MD, Henry R. Boucher MD

{"title":"外周神经阻滞可减少全髋关节置换术后的早期医疗并发症、脱位和阿片类药物用量。","authors":"Brian P. McCormick MD, Sean B. Sequeira MD, Mark D. Hasenauer MD, Robert P. McKinstry MD, Frank R. Ebert MD, Henry R. Boucher MD","doi":"10.1016/j.artd.2024.101587","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Peripheral nerve blocks (PNBs) may be utilized for postoperative pain control following total hip arthroplasty (THA). The purpose of this study was to evaluate the association between PNBs and postoperative complication rates, healthcare utilization, and opioid consumption following elective THA.</div></div><div><h3>Methods</h3><div>Opioid-naive patients who received PNBs on the same day as undergoing THA for degenerative etiologies were identified from a large national database and matched 1:5 to a control cohort using propensity scoring. Rates of medical complications, inpatient readmissions, and emergency department presentations occurring within 90 days of THA and surgery-related complications occurring within 1 year of THA were compared using odds ratios. Total cost and perioperative opioid consumption in morphine milligram equivalents (MMEs) per day were also evaluated and compared between groups.</div></div><div><h3>Results</h3><div>Propensity score matching resulted in 4748 PNB patients matched to 23,740 control patients. THA patients who received PNBs had lower incidences of deep vein thrombosis (odds ratio [OR] 0.67, <em>P</em> = .004), urinary tract infection (OR 0.76, <em>P</em> < .001), and dislocation (OR 0.51, <em>P</em> < .001). PNBs were also associated with decreased perioperative opioid consumption (38.6 MME/day vs 55.3 MME/day, <em>P</em> < .001). Regarding healthcare utilization, there were no differences between cohorts in rates of inpatient readmission, emergency department presentation, or total cost.</div></div><div><h3>Conclusions</h3><div>PNBs are associated with decreased risk of deep vein thrombosis, urinary tract infection, and dislocation and decreased perioperative opioid consumption following THA.</div></div><div><h3>Level of evidence</h3><div>III, Retrospective review.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101587"},"PeriodicalIF":1.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732214/pdf/","citationCount":"0","resultStr":"{\"title\":\"Peripheral Nerve Blocks Are Associated With Decreased Early Medical Complications, Dislocations, and Opioid Consumption Following Total Hip Arthroplasty\",\"authors\":\"Brian P. McCormick MD, Sean B. Sequeira MD, Mark D. Hasenauer MD, Robert P. McKinstry MD, Frank R. Ebert MD, Henry R. Boucher MD\",\"doi\":\"10.1016/j.artd.2024.101587\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Peripheral nerve blocks (PNBs) may be utilized for postoperative pain control following total hip arthroplasty (THA). The purpose of this study was to evaluate the association between PNBs and postoperative complication rates, healthcare utilization, and opioid consumption following elective THA.</div></div><div><h3>Methods</h3><div>Opioid-naive patients who received PNBs on the same day as undergoing THA for degenerative etiologies were identified from a large national database and matched 1:5 to a control cohort using propensity scoring. Rates of medical complications, inpatient readmissions, and emergency department presentations occurring within 90 days of THA and surgery-related complications occurring within 1 year of THA were compared using odds ratios. Total cost and perioperative opioid consumption in morphine milligram equivalents (MMEs) per day were also evaluated and compared between groups.</div></div><div><h3>Results</h3><div>Propensity score matching resulted in 4748 PNB patients matched to 23,740 control patients. THA patients who received PNBs had lower incidences of deep vein thrombosis (odds ratio [OR] 0.67, <em>P</em> = .004), urinary tract infection (OR 0.76, <em>P</em> < .001), and dislocation (OR 0.51, <em>P</em> < .001). PNBs were also associated with decreased perioperative opioid consumption (38.6 MME/day vs 55.3 MME/day, <em>P</em> < .001). Regarding healthcare utilization, there were no differences between cohorts in rates of inpatient readmission, emergency department presentation, or total cost.</div></div><div><h3>Conclusions</h3><div>PNBs are associated with decreased risk of deep vein thrombosis, urinary tract infection, and dislocation and decreased perioperative opioid consumption following THA.</div></div><div><h3>Level of evidence</h3><div>III, Retrospective review.</div></div>\",\"PeriodicalId\":37940,\"journal\":{\"name\":\"Arthroplasty Today\",\"volume\":\"31 \",\"pages\":\"Article 101587\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732214/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroplasty Today\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352344124002723\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344124002723","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：周围神经阻滞（PNBs）可用于全髋关节置换术（THA）术后疼痛控制。本研究的目的是评估选择性全髋关节置换术后pnb与术后并发症发生率、医疗保健利用和阿片类药物消耗之间的关系。方法：从一个大型国家数据库中确定在接受退行性病因THA的同一天接受pnb的阿片类药物新手患者，并使用倾向评分与对照队列进行1:5匹配。采用优势比比较THA术后90天内发生的医疗并发症、住院再入院率和急诊科就诊率以及THA术后1年内发生的手术相关并发症。还评估和比较各组之间每天吗啡毫克当量（MMEs）的总成本和围手术期阿片类药物消耗。结果：倾向评分匹配，4748例PNB患者与23740例对照患者匹配。接受pnb治疗的THA患者深静脉血栓形成（比值比[OR] 0.67, P = 0.004）、尿路感染（比值比[OR] 0.76, P < 0.001）、脱位（比值比[OR] 0.51, P < 0.001）发生率较低。pnb还与围手术期阿片类药物消耗减少相关（38.6 MME/天vs 55.3 MME/天，P < 0.001）。在医疗保健利用方面，各队列在住院再入院率、急诊科就诊率或总费用方面没有差异。结论：PNBs与THA术后深静脉血栓形成、尿路感染和脱位风险降低以及围手术期阿片类药物消耗减少有关。证据等级：III，回顾性评价。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Peripheral Nerve Blocks Are Associated With Decreased Early Medical Complications, Dislocations, and Opioid Consumption Following Total Hip Arthroplasty

Background

Peripheral nerve blocks (PNBs) may be utilized for postoperative pain control following total hip arthroplasty (THA). The purpose of this study was to evaluate the association between PNBs and postoperative complication rates, healthcare utilization, and opioid consumption following elective THA.

Methods

Opioid-naive patients who received PNBs on the same day as undergoing THA for degenerative etiologies were identified from a large national database and matched 1:5 to a control cohort using propensity scoring. Rates of medical complications, inpatient readmissions, and emergency department presentations occurring within 90 days of THA and surgery-related complications occurring within 1 year of THA were compared using odds ratios. Total cost and perioperative opioid consumption in morphine milligram equivalents (MMEs) per day were also evaluated and compared between groups.

Results

Propensity score matching resulted in 4748 PNB patients matched to 23,740 control patients. THA patients who received PNBs had lower incidences of deep vein thrombosis (odds ratio [OR] 0.67, P = .004), urinary tract infection (OR 0.76, P < .001), and dislocation (OR 0.51, P < .001). PNBs were also associated with decreased perioperative opioid consumption (38.6 MME/day vs 55.3 MME/day, P < .001). Regarding healthcare utilization, there were no differences between cohorts in rates of inpatient readmission, emergency department presentation, or total cost.

Conclusions

PNBs are associated with decreased risk of deep vein thrombosis, urinary tract infection, and dislocation and decreased perioperative opioid consumption following THA.

Level of evidence

III, Retrospective review.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.