• Jimmy J Chan, Evan Garden, Jesse C Chan, Jashvant Poeran, Nicole Zubizarreta, Madhu Mazumdar, Leesa M Galatz, and Ettore Vulcano.
• Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, 5th Floor, New York, NY, 10019, USA.
• J Anesth. 2021 Dec 1; 35 (6): 879888879-888.

PurposeAnkle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes.MethodsThis retrospective cohort study utilized data from the nationwide database (2006-2016) on TAA (n = 5,290) and ankle arthrodesis (n = 14,709) procedures. PNB use was defined from billing; outcomes included opioid utilization, length and cost of stay, discharge to a skilled nurse facility, and opioid-related complications. Mixed-effects models estimated the association between PNB use and outcomes, separate by procedure type and inpatient/outpatient setting. We report odds ratios and 95% confidence intervals (CI).ResultsOverall, PNB was utilized in 8.7% of TAA and 9.9% of ankle arthrodesis procedures, with increased utilization from 2006 to 2016 of 2.6% to 11.3% and 5.2% to 12.0%, respectively. After adjustment for relevant covariates, PNB use was significantly associated with decreased total opioid utilization specifically in the inpatient setting in TAA ( - 16.9% CI  - 23.9%;  - 9.1%) and ankle arthrodesis procedures ( - 18.9% CI  - 24.4;  - 13.0%), this was particularly driven by a decrease in opioid utilization on the day of surgery. No clinically relevant effects were observed for other outcomes.ConclusionPNB utilization is associated with substantial reductions in opioid utilization, particularly in the inpatient setting. Our study is in support of a wider use of this analgesic technique, which may translate into more benefits in terms of clinical outcomes and resource utilization.Level Of EvidenceIII.© 2021. Japanese Society of Anesthesiologists.

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