Beta-blocker Use is Associated with a Reduction in Opioid Use 30 Days After Total Knee Arthroplasty.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) can lead to chronic pain and prolonged postoperative opioid use. There are few evidence-based interventions to prevent these outcomes. Recently, beta-blockers have emerged as possible novel analgesics. OBJECTIVES: The objective of this study was to determine whether perioperative beta-blocker use is associated with reduced prolonged postoperative opioid use after TKA. STUDY DESIGN: This study used a retrospective cohort design. SETTING: The research took place within Department of Veterans Affairs hospitals in the United States between April 2012 and April 2016. METHODS: Patients IRB approval was obtained to examine the records of Veterans Affairs (VA) patients undergoing TKA. Patients using opioids 60 days before surgery were excluded. INTERVENTION The intervention being investigated was perioperative beta-blocker use, overall and by class. MEASUREMENT Oral morphine equivalent usage through postoperative day 1 and prescription opioid refills through 30, 90, and 365 days after TKA were recorded. Adjusted models were created controlling for relevant demographic and comorbidity covariates. A secondary analysis examined the same outcomes separated by beta-blocker class. RESULTS: The cohort was 93.8% male with a mean age of 66 years. Among the 11,614 TKAs that comprised the cohort, 2,604 (22.4%) were performed on patients using beta-blockers. After adjustment, beta-blocker use was associated with reduced opioid use through 30 days after surgery (odds ratio [OR] 0.89 [95% confidence interval (CI), 0.80-0.99], P = .026). Selective beta-blockers were associated with reduced opioid use at 30 days (OR 0.88 [95% CI, 0.78-0.98], P = .021), and nonselective beta-blockers were associated with reduced oral morphine equivalent usage through postoperative day 1 (beta = -17.9 [95% CI, -29.9 to -5.8], P = .004). LIMITATIONS: Generalizability of these findings is uncertain, because this study was performed on a cohort of predominantly white, male VA patients. This study also measured opioid use, but opioid use is not a perfect surrogate for pain. Nevertheless, opioid use offers value as an objective measure of pain persistence in a national cohort for which patient-reported outcomes are otherwise unavailable. CONCLUSIONS: Perioperative beta-blocker use was associated with reduced prescription opioid use at 30 days after surgery. Both selective and nonselective beta-blockers were associated with reduced opioid use when analyzed individually. KEY WORDS Analgesics, opioid, arthroplasty, replacement, knee, adrenergic beta-antagonists, pain management.