Outcomes After Peripheral Nerve Block in Hip Arthroscopy

Abstract

Pain control following hip arthroscopy presents a significant clinical challenge, with postoperative pain requiring considerable opioid use. Peripheral nerve blocks (PNBs) have emerged as one option to improve pain and limit the consequences of opioid use. The purpose of this study is to provide a comprehensive review of outcomes associated with PNB in hip arthroscopy. We hypothesize that the use of PNB in hip arthroscopy leads to improved outcomes and is associated with few complications. A systematic review of PubMed, Medline, Scopus, and Embase databases was conducted through January 2015 for English-language articles reporting outcome data, with 2 reviewers independently reviewing studies for inclusion. When available, similar outcomes were combined to generate frequency-weighted means. Six studies met the inclusion criteria for this review, reporting on 710 patients undergoing hip arthroscopy. The mean ages were 37.0 and 37.7 years for the PNB and comparator groups, respectively, with a reported total of 281 (40.5%) male and 412 (59.5%) female patients. Postoperative post-anesthesia care unit (PACU) pain was consistently reduced in the PNB group, with the use of a lower morphine equivalent dose and lower rates of inpatient admission, compared with that in the control groups. Postoperative nausea and/or vomiting as well as PACU discharge time showed mixed results. High satisfaction and few complications were reported. In conclusion, PNB is associated with reductions in postoperative pain, analgesic use, and the rate of inpatient admissions, though similar rates of nausea/vomiting and time to discharge were reported. Current PNB techniques are varied, and future research efforts should focus on examining which of these methods provides the optimal risk-benefit profile in hip arthroscopy.

Utilization of a Continuous Pericapsular Nerve Group (PENG) Block with an Opioid-Sparing Repair of a Femoral Neck Fracture in a Pediatric Patient

“…Cannulated screw fixation is usually required for older children in whom transcervical fracture is unstable, and the determination of open versus closed approach commonly depends on the success of surgical traction for reduction. Regional anesthetic techniques are safe in children [ 14 – 16 ] and can provide analgesia for pediatric patients undergoing hip surgery [ 3 – 6 ]. Adequate analgesia results in faster rehabilitation, decreased opioid consumption, and avoidance of the untoward side effects associated with opioids.…”

“…As such, regional anesthesia is advantageous in providing sufficient analgesia while reducing the adverse effects of opioids. Lumbar plexus blockade, neuraxial techniques (caudal or epidural), and combined femoral nerve and fascia iliaca blockade have been shown in a myriad of pediatric studies to exhibit opioid-sparing effects and lower postoperative pain scores in patients who are suffering from hip pain [ 3 – 6 ].…”

“…Despite the success of neuraxial techniques in decreasing postoperative pain scores in pediatric patients undergoing hip surgery [ 4 – 6 ], positioning requirements, bilateral sensory and motor blockade, and urinary retention limit their use. Our institutional practice includes administration of a general anesthetic combined with a lumbar plexus continuous nerve block for children undergoing unilateral hip surgery.…”

A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

“…When evaluating hip arthroscopy, peripheral nerve blocks have been proven to be an effective method of analgesia with a relatively low complication rate. 3 , 9 , 10 , 11 , 12 , 13 Dold et al. 21 have reported that femoral nerve blocks were found to be more effective than general anesthesia alone with standard pain medications at reducing pain levels 60 minutes postoperatively.…”

“… 9 , 10 Generally, regional nerve blocks have proven effective in hip arthroscopy and are commonly employed as part of a multimodal pain control plan. 9 , 10 , 11 , 12 , 13 As the prevalence of hip arthroscopy has increased in recent years, so has the search for the most effective and safest technique for postoperative analgesia in these patients.…”