Peri-operative pain management in hip arthroscopy: a systematic review of the literature

Abstract

The purpose of this article was to review current literature on peri-operative pain management in hip arthroscopy. A systematic review of the literature on pain control in hip arthroscopy published January 2008 to December 2018 was performed. Inclusion criteria consisted of English language or articles with English translations, subjects undergoing hip arthroscopy with documented peri-operative pain control protocols in studies reporting Level I to IV evidence. Exclusion criteria were non-English articles, animal studies, prior systematic review or meta-analyses, studies not reporting peri-operative pain control protocols, studies documenting only pediatric (<18 years of age) patients, studies with Level V evidence and studies including less than five subjects. Statistical analysis was performed to assess pain protocols on narcotic consumption in PACU, VAS score on discharge, time to discharge from PACU and incidence of complications. Seventeen studies were included, comprising 1674 patients. Nerve blocks were administered in 50% of patients (n = 838 of 1674), of which 88% (n = 740 of 838) received a pre-operative block while 12% (n = 98 of 838) post-operative block. Sixty-eight complications were recorded: falls (54%, n = 37), peripheral neuritis (41%, n = 28), seizure (1.5%, n = 1), oxygen desaturation and nausea (1.5%, n = 1) and epidural spread resulting in urinary retention (1.5%, n = 1). No significant differences in narcotic consumption, VAS score at discharge, time until discharge or incidence of complication was found based on pain control modality utilized. No statistically significant difference in PACU narcotic utilization, VAS pain scores at discharge, time to discharge or incidence of complications was found between peri-operative pain regimens in hip arthroscopy.

A comprehensive three-phase opiate sparing multimodal pain protocol for hip arthroscopy: a retrospective review

“…Yuan et al also found that subjects who received a QL block had lower VAS pain scores in the PACU and within the first 24 h post-operatively when compared with a control group [ 13 ]. In this study, mean overall PACU VAS score (4.0 ± 2.0) in patients treated using our multimodal pain protocol was lower when compared with a recent systematic review examining 17 studies reporting on perioperative pain control following hip arthroscopy, which reported a mean PACU VAS score of 4.79 ± 2.04 [ 3 ]. In the retrospective review by Childs et al, the authors reported a mean VAS score of 4.28 in 88 patients undergoing primary hip arthroscopy who received only local analgesia into the portal sites [ 14 ].…”

“…Patients using the senior authors opiate sparing pain protocol used an average of ∼4 Meq of opioids in the recovery room, which correlates to less than one 5 mg oxycodone tablet or about a 0.5 mg of IV hydromorphone. Recent systematic reviews have reported that the average opioid consumption in the recovery room ranges from 0 to 32.53 Meq in patients receiving non-narcotic interventions for perioperative pain control [ 3 , 4 , 17 ]. Compared to the current multimodal pain regimen, greater opioid consumptions has been reported in studies utilizing the following modalities: PNB and preoperative non-narcotic medications [ 6 , 22 ], PNB and intraoperative local injection analgesia [ 16 , 23 ], pre-operative non-narcotic medications and local injection analgesia [ 2 ], and preoperative non-narcotic medications, intraoperative local injection analgesia with optional PNB post-operatively [ 21 ].…”

“…Despite its minimally invasive nature and performance as primarily an outpatient procedure, pain control continues to be a challenge [ 2–6 ]. This challenge is likely due to the combination of the surgery itself and the complex innervation of the hip joint [ 3 , 7 ]. Inadequate pain control following hip arthroscopy has been shown to lead to prolonged discharge times, unexpected hospital admission, and higher consumption of opioid narcotics [ 3 ].…”

“…This challenge is likely due to the combination of the surgery itself and the complex innervation of the hip joint [ 3 , 7 ]. Inadequate pain control following hip arthroscopy has been shown to lead to prolonged discharge times, unexpected hospital admission, and higher consumption of opioid narcotics [ 3 ]. As a result, perioperative pain regimens have been developed to improve pain control following hip arthroscopy, utilizing a combination of non-narcotic medications, peripheral nerve blocks and local injection analgesia [ 3 , 4 ].…”

“…Inadequate pain control following hip arthroscopy has been shown to lead to prolonged discharge times, unexpected hospital admission, and higher consumption of opioid narcotics [ 3 ]. As a result, perioperative pain regimens have been developed to improve pain control following hip arthroscopy, utilizing a combination of non-narcotic medications, peripheral nerve blocks and local injection analgesia [ 3 , 4 ]. The goal of these regimens is to decrease pain and opioid consumption, allowing early mobilization, and timely discharge following arthroscopic hip surgery.…”