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Bailey TL, Stephens AR, Adeyemi TF, Xu Y, Presson AP, Aoki SK, Maak TG. Traction Time, Force and Postoperative Nerve Block Significantly Influence the Development and Duration of Neuropathy Following Hip Arthroscopy. Arthroscopy 2019; 35:2825-2831. [PMID: 31604499 DOI: 10.1016/j.arthro.2019.03.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) evaluate the individual and combined effects of traction time and traction force on postoperative neuropathy following hip arthroscopy, (2) determine if perioperative fascia iliaca block has an effect on the risk of this neuropathy, and (3) identify if the these items had a significant association with the presence, location, and/or duration of postoperative numbness. METHODS Between February 2015 and December 2016, a consecutive cohort of hip arthroscopy patients was prospectively enrolled. Traction time, force, and postoperative nerve block administration were recorded. The location and duration of numbness were assessed at postoperative clinic visits. Numbness location was classified into regions: 1, groin; 2, lateral thigh; 3, medial thigh; 4, dorsal foot; and 5,preoperative thigh or radiculopathic numbness. RESULTS A total of 156 primary hip arthroscopy patients were analyzed, 99 (63%) women and 57 (37%) men. Mean traction time was 46.5 ± 20.3 minutes. Seventy-four patients (47%) reported numbness with an average duration of 157.5 ± 116.2 days. Postoperative fascia iliaca nerve block was a significant predictor of medial thigh numbness (odds ratio, 3.36; 95% confidence interval, 1.46-7.76; P = .04). Neither traction time nor force were associated with generalized numbness (P = .85 and P = .40, respectively). However, among those who experienced numbness, traction time and force were greater in patients with combined groin and lateral thigh numbness compared with those with isolated lateral thigh or medial thigh numbness (P = .001 and P = .005, respectively). CONCLUSIONS Postoperative neuropathy is a well-documented complication following hip arthroscopy. Concomitant pudendal and lateral femoral cutaneous nerve palsy may be related to increased traction force and time, even in the setting of low intraoperative traction time (<1 hour). Isolated medial thigh numbness is significantly associated with postoperative fascia iliaca blockade. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Travis L Bailey
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Temitope F Adeyemi
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Yizhe Xu
- Division of Public Health, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah, U.S.A
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
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A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery: A randomized controlled clinical trial. J Clin Anesth 2018; 49:26-29. [DOI: 10.1016/j.jclinane.2018.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022]
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Yu HC, Al-Shehri M, Johnston KD, Endersby R, Baghirzada L. Anesthesia for hip arthroscopy: a narrative review. Can J Anaesth 2016; 63:1277-90. [PMID: 27530361 DOI: 10.1007/s12630-016-0718-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/19/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hip arthroscopy is a minimally invasive surgical procedure indicated for the treatment of specific hip disorders. In this narrative review, we aim to examine the key components in providing anesthesia for this procedure. SOURCE MEDLINE(®), PubMed, and EMBASE™ databases were searched for peer-reviewed articles discussing the anesthetic management of patients undergoing hip arthroscopy. PRINCIPAL FINDINGS The primary anesthetic regimen used for hip arthroscopy should balance patient factors, preferences of the surgeon, and the demands of the procedure itself. Both general and neuraxial anesthetic techniques are well suited for this mostly ambulatory surgical procedure. There is a lack of current literature specifically comparing the benefits and risks of the two techniques in this setting. Postoperative pain management consists mainly of intravenous and oral opioids; however, a variety of regional anesthesia techniques, such as lumbar plexus block and fascia iliaca block, can be performed pre- or postoperatively. Overall, hip arthroscopy is safe, although positioning-related difficulties, extravasation of irrigation fluid, hypothermia, infections, and thromboembolic events are potential perioperative complications that warrant specific monitoring and prompt treatment. CONCLUSIONS Until now, the anesthetic technique for hip arthroscopy has not been well studied. Thus, increasing emphasis should be directed towards examining relevant clinical outcomes that can better inform evidence-based decision-making in the anesthetic management of hip arthroscopy patients. In the meantime, awareness of potential complications and vigilant monitoring are paramount in providing safe anesthetic care for patients undergoing hip arthroscopy.
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Affiliation(s)
- Hai Chuan Yu
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mohammed Al-Shehri
- Division of Orthopedics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kelly D Johnston
- Division of Hip & Knee Reconstruction, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Ryan Endersby
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Leyla Baghirzada
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada. .,Department of Anesthesia, South Health Campus, 4448 Front Street, SE, Calgary, AB, T3M 1M4, Canada.
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Xing JG, Abdallah FW, Brull R, Oldfield S, Dold A, Murnaghan ML, Whelan DB. Preoperative Femoral Nerve Block for Hip Arthroscopy: A Randomized, Triple-Masked Controlled Trial. Am J Sports Med 2015; 43:2680-7. [PMID: 26403206 DOI: 10.1177/0363546515602468] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopy has become a standard method of treatment for a variety of intra-articular hip disorders. While most arthroscopic hip procedures are performed as outpatient surgeries, patients can still experience significant postoperative pain and opioid-associated side effects. PURPOSE The potential benefits of a preoperative femoral nerve block (FNB) in hip arthroscopy were explored in a previous retrospective review. The study objective was to confirm these findings in a prospective randomized study. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Fifty patients undergoing hip arthroscopy were included in this prospective, single-center, randomized controlled trial that was patient-, operator-, and assessor-blinded. Patients received either a preoperative ultrasound-guided FNB with 20 mL of 0.5% bupivacaine (FNB group) or normal saline (control group). Nerve blockade was confirmed via standardized sensory testing before the induction of general anesthesia. The primary endpoint was cumulative consumption of oral morphine equivalent at 24 hours after discharge. Secondary endpoints included opioid use at various time points, pain scores, Quality of Recovery (QoR-27) score, incidence of nausea and vomiting, time to discharge, block-related complications, falls at 24 hours, and patient satisfaction. RESULTS Fifty patients completed the study, including 27 in the FNB group and 23 in the control group. Most patient characteristics were statistically similar between groups except for operative time, which was longer in the control group. Cumulative oral morphine consumption was lower in the FNB group at 48 hours; there was no difference at 24 hours or 7 days postoperatively. Pain scores were significantly lower up to 6 hours postoperatively in the FNB group compared with control; however, rebound pain was observed at 24 hours after discharge in patients who received FNB. There was no difference in most secondary outcomes. Importantly, a total of 6 patients in the FNB group reported falls (without injury) within the first 24 hours postoperatively compared with none in the control group. Patient satisfaction with pain control was high in both groups at all time points. CONCLUSION Preoperative FNB may improve early pain control after hip arthroscopy. However, given the observed risk of falls, the routine use of FNB for outpatient hip arthroscopy cannot be recommended.
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Affiliation(s)
- Jerry G Xing
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Faraj W Abdallah
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Richard Brull
- Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
| | - Stephanie Oldfield
- Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrew Dold
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - M Lucas Murnaghan
- Division of Orthopaedic Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel B Whelan
- Division of Orthopaedic Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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Potter MQ, Sun GS, Fraser JA, Beckmann JT, Swenson JD, Maak TG, Aoki SK. Psychological distress in hip arthroscopy patients affects postoperative pain control. Arthroscopy 2014; 30:195-201. [PMID: 24485112 DOI: 10.1016/j.arthro.2013.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 11/10/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether patients with higher levels of preoperative psychological distress more frequently use a postoperative fascia iliaca nerve block for pain control after hip arthroscopy, and to determine whether a fascia iliaca nerve block is an effective adjunct to multimodal oral and intravenous analgesia after hip arthroscopy. METHODS One hundred seven patients undergoing hip arthroscopy were prospectively enrolled. Before surgery, patients were administered the Distress Risk Assessment Method questionnaire to quantify their level of preoperative psychological distress. Postoperatively, patients with pain inadequately controlled by multimodal oral and intravenous analgesics could request and receive a fascia iliaca nerve block. Pain scores, opioid consumption, time in the post-anesthesia care unit (PACU), and postoperative complications were recorded for all patients. RESULTS Patients with normal Distress Risk Assessment Method scores requested fascia iliaca nerve blocks approximately half as frequently (18 of 50 [36%]) as patients in the at-risk category (28 of 47 [60%]) or distressed category (7 of 10 [70%]) (P = .02). Patients with high levels of distress also received 40% more intraoperative opioid than patients with normal scores (P = .04). In the study population as a whole, patients who received a fascia iliaca nerve block (n = 53) had a higher initial visual analog scale (VAS) pain score in the PACU (7.2 ± 0.3 v 5.5 ± 0.4, P = .001) and showed greater improvement in the VAS pain score by PACU discharge (-4.3 ± 0.2 v -2.1 ± 0.3, P ≤ .0001) compared with patients who did not receive a block (n = 54). CONCLUSIONS Patients with higher levels of preoperative psychological distress more frequently requested a postoperative nerve block to achieve adequate pain control after hip arthroscopy. Patients receiving a block had greater improvement in VAS pain scores compared with patients managed with oral and intravenous analgesics alone. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Michael Q Potter
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Grant S Sun
- School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jennifer A Fraser
- Department of Anesthesia, University of Utah, Salt Lake City, Utah, U.S.A
| | - James T Beckmann
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeffrey D Swenson
- Department of Anesthesia, University of Utah, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.
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