Regional Anesthesia in Thumb Carpometacarpal Arthroplasty: Increased Costs Without Differences in Early Emergency Department Visits or Opioid Prescriptions.

PURPOSE: First carpometacarpal (CMC) osteoarthritis is increasingly treated with CMC arthroplasty. Perioperative regional nerve blocks are commonly used in upper-extremity surgery to improve postoperative pain control, but their effect on emergency department (ED) visits and opioid use after CMC arthroplasty remains unclear. We evaluated whether perioperative regional nerve blocks were associated with fewer postoperative ED visits and opioid prescriptions after CMC arthroplasty.

METHODS: Using a Health Insurance Portability and Accountability Act-compliant national database of 170 million patients, we identified individuals who underwent first CMC arthroplasty between 2010 and 2023 using Current Procedural Terminology codes. Patients who received a perioperative regional nerve block were matched 1:1 to those who did not by age, sex (male or female as recorded in the database), and Elixhauser Comorbidity Index. Outcomes included ED visits within 7 days, opioid prescriptions (measured in morphine milligram equivalents) within 14 days, and episode-of-care cost.

RESULTS: We identified 181,241 patients who underwent CMC arthroplasty and created two matched cohorts of 33,186 patients each (76.8% women; mean age = 61.48 [standard deviation, 8.42] years). Patients who received a regional nerve block had a higher episode-of-care cost than those who did not ($2,247.00 [quartile 1-quartile 3: $1,136.00 to $3,896.00] vs $1,419.50 [quartile 1-quartile 3: $629.50 to $2,609.90]). The rates of ED visits within 7 days were similar between groups (1.93% vs 1.90%). The numbers of opioid prescriptions within 14 days were also similar (median morphine milligram equivalents = 300.0 [quartile 1-quartile 3: 200.0 to 0.5] vs 300.0 [quartile 1-quartile 3: 200.0 to 500.0]).

CONCLUSIONS: In this matched national cohort, perioperative regional nerve blocks during CMC arthroplasty increased episode-of-care cost without reducing the numbers of short-term ED visits or postoperative opioid prescriptions.

TYPE OF STUDY/LEVEL OF EVIDENCE: Retrospective comparative study III.