{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:08:59Z","timestamp":1792613339551,"version":"4.5.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Postoperative pain control after total knee arthroplasty (TKA) remains challenging, particularly in patients utilizing chronic opioids preoperatively. Our study aimed to evaluate the effect of regional nerve blockade on perioperative pain control outcomes after TKA in patients using or not using chronic preoperative opioids. A retrospective review of our institutional database identified 434 chronic opioid patients defined as documented ongoing use greater than 3 months prior to contemporary TKA. Patients were 1:1 matched to nonopioid users based upon age, sex, body mass index, and regional block type (single-shot adductor canal block [ACB, 29%], 3-day ACB catheter [31%], or no block [41%]). All patients underwent primary TKA using periarticular injections and contemporary multimodal pain management. Immediate and 90-day postoperative outcomes, including Knee Osteoarthritis Outcome Score, Junior (KOOS, Jr), were compared via univariate analysis among the matched cohort and regional block type among chronic opioid patients. Chronic opioid patients demonstrated higher inpatient opioid use than controls (90 vs. 65 oral morphine equivalents [OMEs], respectively, p\u2009&lt;\u20090.01), but no significant differences existed in length of stay (LOS), discharge pain scores, 90-day readmission or KOOS, Jr (all p \u2265 0.05). When comparing chronic opioid patients according to block type, those receiving no block had the highest LOS (1.6 days, p\u2009&lt;\u20090.01), discharge pain score (5.0, p\u2009&lt;\u20090.01), and inpatient opioid use (80 OMEs, p\u2009&lt;\u20090.01) compared with either ACB. The subgroup receiving an ACB catheter demonstrated a significantly higher 90-day readmission rate (9%, p\u2009&lt;\u20090.05). Patients utilizing chronic opioids preoperatively require more opioids in the immediate postoperative period after TKA compared with nonopioid users despite contemporary modalities. Nonetheless, the use of any type of ACB provides improved pain control in these patients.<\/jats:p>","DOI":"10.1055\/a-2672-2907","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T22:57:15Z","timestamp":1753916235000},"page":"057-062","source":"Crossref","is-referenced-by-count":1,"title":["Regional Nerve Blocks for Primary Total Knee Arthroplasty in Chronic Opioid Patients"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0193-983X","authenticated-orcid":false,"given":"Cameron K.","family":"Ledford","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6927-9036","authenticated-orcid":false,"given":"Nicolas E.","family":"Giusti","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Ubl","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mason R.","family":"Kapple","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Clendenen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K.","family":"Wilke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"issue":"416","key":"ref1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/01.blo.0000092983.12414.e9","article-title":"Predicting total knee replacement pain: a prospective, observational study","author":"V A Brander","year":"2003","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1016\/j.arth.2023.04.058","article-title":"Patients undergoing primary, cementless TKA had similar pain, opioid utilization, and functional outcomes compared to matched patients with cemented fixation","volume":"38","author":"B P Chalmers","year":"2023","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/bja\/aeu441","article-title":"Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis","volume":"114","author":"G N Lewis","year":"2015","journal-title":"Br J Anaesth"},{"issue":"03","key":"ref4","first-page":"e56150","article-title":"Total knee arthroplasty with and without schedule II opioids: a randomized, double-blinded, placebo-controlled trial","volume":"16","author":"P F Young","year":"2024","journal-title":"Cureus"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.arth.2019.02.059","article-title":"Early in-hospital pain control is a stronger predictor for patients requiring a refill of narcotic pain medication compared to the amount of narcotics given at discharge","volume":"34","author":"B K Wilke","year":"2019","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.arth.2016.02.068","article-title":"Long-acting opioid use independently predicts perioperative complication in total joint 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increases complications and resource utilization after primary total joint arthroplasty","volume":"38","author":"D N Pagan","year":"2023","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.arth.2012.06.039","article-title":"Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty","volume":"28","author":"E Y Chan","year":"2013","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"2390","DOI":"10.1016\/j.arth.2017.03.014","article-title":"Opioid use after total knee arthroplasty: trends and risk factors for prolonged use","volume":"32","author":"N A Bedard","year":"2017","journal-title":"J Arthroplasty"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"e2983","DOI":"10.1097\/MD.0000000000002983","article-title":"Comparison of adductor canal 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A GRADE analysis of the evidence through a systematic review and meta-analysis","volume":"32","author":"M J Kuang","year":"2017","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13018-017-0621-0","article-title":"Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a meta-analysis","volume":"12","author":"Y Tang","year":"2017","journal-title":"J Orthop Surg Res"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1016\/j.arth.2017.12.042","article-title":"Comparison of periarticular local infiltration analgesia with femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials","volume":"33","author":"L K Zhang","year":"2018","journal-title":"J Arthroplasty"},{"issue":"48","key":"ref19","doi-asserted-by":"crossref","first-page":"e13391","DOI":"10.1097\/MD.0000000000013391","article-title":"A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage","volume":"97","author":"Z Tan","year":"2018","journal-title":"Medicine (Baltimore)"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain - United States, 2022","volume":"71","author":"D Dowell","year":"2022","journal-title":"MMWR Recomm Rep"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2672-2907.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:48:13Z","timestamp":1767916093000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2672-2907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":20,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,8]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2672-2907","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7,30]]},"published":{"date-parts":[[2025,7,30]]}}}