Background: Continuous Peripheral Nerve Block (CPNB) is available as part of a multimodal analgesia regimen for post-operative pain management in total knee arthroplasty (TKA). A recent meta-analysis suggested a reduced need for opioids during the early postoperative period in TKA patients who received CPNB for pain management (1). However, a decreasing trend in CPNB use in TKA male patients was reported using data between 2010 and 2014 in Veteran Affairs and Premier Healthcare Database (PHD) (2). This current work was conducted to gain further insight into trends of CPNB utilization in TKA across four large U.S. administrative databases.
Objectives: To describe current trends from 2010 - 2020 in CPNB use in all TKA procedures using data from four large U.S. administrative databases.
Methods: We identified all patients who underwent primary or revision TKA in an inpatient or outpatient setting, in PHD, IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental and Coordination of Benefits Database (MDCR), and IBM® MarketScan® Commercial Claims and Encounters Database (CCAE) between January 1, 2010, and December 31, 2020. CPNB use in these patients was identified using relevant CPT codes. Frequency counts and percentages for CPNB use in TKA were calculated and summarized by year.
Results: A total of 1,673,750, 451,788, 243,770, and 78,909 patients who underwent TKA were identified in PHD, CCAE, MDCR, and MDCD, respectively. In PHD, CPNB use was stable until 2017 beyond which there was an increase in CPNB use from 2017 (0.6%) to 2020 (3.5%). CCAE showed a decreasing trend in CPNB use until 2015 followed by a stable trend between 2016 – 2020, averaging 10.4%. MDCR showed a similar decreasing trend in CPNB use until 2018, beyond which there was an increase averaging 12.7% in 2019 and 2020. In MDCD, a decreasing trend in CPNB use was noted until 2018 with an increase in CPNB use from 2018 (5.9%) to 2020 (8.4%). Increase in outpatient TKA procedures and CPNB use was observed in all 4 data sources starting in 2018.
Conclusions: The analyses of these data suggest either a stable or a decreasing trend in TKA CPNB use until 2017 beyond which an increasing trend was noted in CPNB use primarily in outpatient TKA procedures. This increase coincides with the Center for Medicaid and Medicare Services’ decision to remove TKA as an inpatient-only procedure starting January 1, 2018 (3).
