Conference Coverage

Does a Preoperative Peripheral Nerve Block Reduce Long-Term Opioid Use After Shoulder and Knee Surgery?

Anthony Calabro, MA

Key Highlights

  • More than 18% of patients received postoperative opioid prescriptions within 6 months after surgery.
  • Patients with a preoperative PNB were less likely to report continued opioid use at 1 month (33% vs 62%).
  • Peripheral nerve blocks recipients more frequently declined further opioid prescriptions, citing lack of need.
  • The surgeon performing the procedure significantly influenced opioid prescribing patterns.

In their retrospective review, researchers examined how preoperative peripheral nerve block (PNB) use affects postoperative opioid consumption following shoulder and knee surgeries. Their key findings, presented at the ANESTHESIOLOGY Annual Meeting in San Antonio, TX, revealed that patients who received PNBs were less likely to continue opioid use and more likely to report no further need for opioid prescriptions, indicating a potential role of regional anesthesia in reducing prolonged opioid dependence.

Despite increasing emphasis on opioid-sparing strategies, opioids remain a mainstay in postoperative pain control. Previous studies have shown that regional anesthesia reduces opioid consumption in the immediate postoperative period (24–72 hours), but limited evidence has assessed its longer-term effects. This study sought to clarify whether preoperative PNBs influence opioid use over the months following orthopedic procedures.

For their study, researchers conducted a retrospective review of 533 patients who underwent total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), or knee arthroscopy between July 1, 2021, and July 1, 2024. Patients were stratified by whether they received a preoperative PNB and by opioid refill patterns within 1, 3, and 6 months after surgery, as recorded in the EPIC electronic medical record. Additionally, 168 patients completed a phone questionnaire assessing postoperative analgesic use and attitudes toward opioid prescriptions.

Among the 533 patients, 59 (11.07%) did not receive a PNB. In this group, 8.47% received opioid refills within 1 month, 5.08% within 3 months, and 1.69% within 6 months. Among patients who did receive a PNB, 15.82% received a refill within 1 month, 3.38% within 3 months, and 1.27% within 6 months. A significant association was observed between the operating physician and opioid prescribing likelihood at 1 month (P = .003). Survey responses revealed that continued opioid use at 1 month was significantly higher among patients without a PNB (62%) compared with those who received one (33%; P = .01). Furthermore, PNB recipients were more likely to decline additional prescriptions due to lack of perceived need (P = .025).

Despite the potential benefits of PNBs, more than 18% of all patients continued to use opioids up to 6 months after surgery, highlighting that regional anesthesia alone may not eliminate long-term dependence.

“The follow-up questionnaire suggests that preoperative PNBs may play a crucial role in reducing prolonged opioid use and influencing patient perception of pain management,” the authors concluded. “More research is needed to explore the factors that influence chronic opioid usage in patients receiving a preoperative nerve block for shoulder or knee surgeries.”

Reference
Quintana M, Gibbs C, Ahmadzadeh S, et al. The influence of ongoing opioid use in patients with ultrasound guided blocks for shoulder and knee surgeries, a 6-month clinical review. Presented at: American Society of Anesthesiologists (ASA) Annual Meeting; 2025; New Orleans, LA. https://www.asahq.org/annualmeeting/attend