Reduction of Hip Arthroscopy Post-Operative Pain Using Ultrasound-guided Fascia-Iliaca Block: A Prospective Randomized Control Trial

Glomset, John L; Kim, Eugene J.; Tokish, John M.; Renfro, Suzanne; Seckel, Tyler B.; Adams, Kyle; Folk, Jason

doi:10.1177/2325967118s00149

Cited by 1 publication

(4 citation statements)

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“… 44 2016 Low Unclear High High Low Low Glomset et al. 45 2020 Low Unclear Low High Unclear Low Hanson et al 46 2013 Low Low High Low Low Low Hartwell et al. 47 2020 High High Low High High Low Hsu et al 48 2013 Low Low Low Low Low Low Jeske et al 49 2011 Low Low High Low Low High Kager et al 50 2011 Low Low High Low Unclear Low Kahlenberg et al 51 2017 Unclear Low …”

Section: Resultsmentioning

confidence: 99%

“…FNB = Saline, at 90 minutes and 24 hours Total morphine consumed: ∗FNB < Saline, from 24 to 48 hours. FNB = Saline, from 1-24 hours and from days 2-7 Saline Saline 23 31 ± 8 Purcell et al., 2019 77 1 96% labral repair, 93% pincer resection, 87% cam osteoplasty, 83% capsular repair Nerve block PB: Plain bupivacaine 40 mL of .25% plain bupivacaine (100 mg) 37 military veterans 30.2 DVPRS: PB = LB + PB, from the PACU until 2 weeks Oxycodone Consumed: PB = LB + PB, from days 1-14 LB + PB: Liposomal bupivacaine + plain bupivacaine 20 mL of .5% plain bupivacaine (100 mg) + 20 mL of liposomal bupivacaine (266 mg) 33 military veterans 32.8 Glomset et al., 2020 45 1 Labral repair with both acetabuloplasty and femoroplasty (76%), labral repair with acetabuloplasty or femoroplasty (14%), other (10%) Nerve block vs. intra-articular injection Ultrasound-guided fascia iliaca block (FIB) Up to 60 mL .35% ropivacaine at 3 mg/kg, with 100-mg clonidine (per 60 mL) and epinephrine 1:400,000 41 40.6 ± 12.4 VAS: FIB = IA, in PACU, and at 2 weeks, 6 weeks, and 3 months Morphine Equivalents: FIB = IA, in PACU Intra-articular (IA) injection, at completion of surgery 20 mL .5% ropivacaine, at the end of surgery 43 36.8 ± 12.1 Cogan et al., 2020 40 1 Hip arthroscopy, labral repair, and acetabuloplasty Intra-articular injection M + C: Morphine + clonidine 11 mL of 10 mg morphine, and 100 mcg clonidine, in .9% NaCl solution, at the conclusion of arthroscopy 33 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…88 The fascia iliaca block also may be an inferior form of pain management, as the fascia iliaca block provides equal pain relief compared to saline placebo. 34,45,77 No RCTs included in this study evaluated the lumbar plexus nerve block; however, it is possible that the lumbar plexus nerve block may provide the best clinical outcomes of the common hip arthroscopy nerve blocks. 96,97 For example, YaDeau et al 97 described in a brief report of an RCT that the addition of a lumbar plexus nerve block with a combined spinal epidural leads to significantly decreased postoperative pain compared to only receiving the spinal epidural.…”

Section: Hip Arthroscopymentioning

confidence: 99%

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Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

Paul

Szukics

Brutico

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To provide an updated review of multimodal pain management in arthroscopic surgery by evaluating pain and opioid consumption after shoulder, knee, and hip arthroscopy. Methods: A comprehensive literature search was performed to identify randomized controlled trials (RCTs) investigating multimodal pain management after shoulder, knee, and hip arthroscopy. Articles were identified from January 2011 through December 2020 using various databases. As the primary outcome variables of this study, differences in postoperative pain and opioid consumption volumes were summarized from all reported postoperative time points. Results: 37 shoulder, 28 knee, and 8 hip arthroscopy RCTs were included in the study. The most frequent bias present in the included RCTs was incomplete outcome data (58%), while group allocation concealment was the least frequent bias (15%). Qualitative analysis of rotator cuff repair (n ¼ 12), anterior cruciate ligament reconstruction (n ¼ 11), meniscectomy (n ¼ 5), femoroacetabular impingement (n ¼ 2), oral medications (n ¼ 8), postoperative interventions (n ¼ 10), and nonpharmacological interventions (n ¼ 6) was performed. Conclusions: Many multimodal pain management protocols offer improved pain control and decreased opioid consumption after arthroscopic surgery. On the basis of the current literature, the evidence supports an interscalene nerve block with a dexamethasone-dexmedetomidine combination for rotator cuff repair, a proximal continuous adductor canal block for anterior cruciate ligament reconstruction, and local infiltration analgesia (e.g., periacetabular injection with 20 mL of .5% bupivacaine) for hip arthroscopy. When evaluating oral medication, the evidence supports 150 mg Pregabalin for shoulder arthroscopy, 400 mg Celecoxib for knee arthroscopy, and 200 mg Celecoxib for hip arthroscopy, all taken preoperatively. There is promising evidence for the use of various nonpharmacological modalities, specifically preoperative opioid education for rotator cuff repair patients; however, more clinical trials that evaluate nonpharmacological interventions should be performed.

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