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Guo Z, Liu G, Li W, Lu S, Zhao Y, Wang L, Cheng C. Preoperative versus postoperative nonsteroidal anti-inflammatory drugs in femoroacetabular impingement patients undergoing hip arthroscopy surgery: analgesic effect, joint function, patients' satisfaction, and quality of life. Inflammopharmacology 2024:10.1007/s10787-024-01540-w. [PMID: 39126566 DOI: 10.1007/s10787-024-01540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic effects on femoroacetabular impingement (FAI) patients undergoing hip arthroscopy surgery (HAS). However, the influence of medication time on the analgesic effect of NSAIDs is uncertain. This study aimed to compare the analgesic effect, joint function, quality of life (QoL), and patients' satisfaction between preoperative and postoperative NSAIDs in these patients. METHODS In this prospective, observational study, 165 FAI patients undergoing HAS with NSAIDs (celecoxib, meloxicam, and nimesulide) for analgesia were divided into preoperative (PRE-A) and postoperative analgesia (POST-A) groups according to their actual medication. RESULTS The visual analog scale (VAS) pain scores on the 1st (P < 0.001) and 3rd (D3) (P = 0.015) days after the operation were lower in the PRE-A group versus the POST-A group but not preoperatively (P = 0.262) or on the 7th day after the operation (D7) (P = 0.302). The proportion of patients receiving rescue analgesia decreased in the PRE-A group versus POST-A group (P = 0.041). However, the modified Harris hip score (mHHS), proportion of patients with an mHHS ≥ 70, and EuroQol-5-dimensional score at preoperative, 1st month (M1), and 3rd month (M3) after the operation were similar between the groups (all P > 0.050). The VAS score on D7 was greater in the PRE-A group compared to the POST-A group (P = 0.014), but the scores at M1 and M3 and the satisfaction and very satisfaction rates at D7, M1, and M3 did not differ between the groups (all P > 0.050). Subgroup analysis revealed that the type of NSAID did not affect most outcomes. CONCLUSION Preoperative NSAIDs elevate analgesic effect and patients' satisfaction, but not joint function or QoL compared to postoperative NSAIDs in FAI patients undergoing HAS.
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Affiliation(s)
- Zhiyuan Guo
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Guangfei Liu
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Weibin Li
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Shouliang Lu
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Ye Zhao
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Lu Wang
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Cai Cheng
- Department of Orthopedics, Cangzhou Central Hospital, No. 16 West Xinhua Road, Cangzhou, 061000, Hebei, China.
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Tanguilig G, Dhillon J, Scillia AJ, Heard WM, Kraeutler MJ. The Addition of a Pericapsular Nerve Group Block for Postoperative Pain Control Does Not Result in Less Narcotic Use After Hip Arthroscopy: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100894. [PMID: 38379602 PMCID: PMC10878844 DOI: 10.1016/j.asmr.2024.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To perform a systematic review of clinical studies evaluating the pericapsular nerve group (PENG) block in patients undergoing hip arthroscopy. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify comparative studies of patients undergoing the PENG block before hip arthroscopy. The search phrase used was hip arthroscopy pericapsular nerve block. Patients were evaluated based on analgesic consumption, time to discharge from the postanesthesia care unit (PACU), and pain scores (Numeric Rating Scale and visual analog scale). The Modified Coleman Methodology Score was used to evaluate study methodology quality. Results Five studies (2 Level I, 3 Level III) met inclusion criteria. The 5 studies included the following comparison groups: 0.9% normal saline injection, general anesthesia alone, and general anesthesia with intraoperative pericapsular bupivacaine injection. The 2 randomized controlled trials included in this review reported no significant difference between groups regarding opioid consumption. One of these did not find any statistically significant differences in their secondary outcomes either, including patient satisfaction with analgesia, opioid-related adverse events, or persistent opioid use at 1 week. However, the other 3 studies found significantly lower opioid consumption in patients receiving the PENG block versus the control group intraoperatively, in the PACU, and/or postoperatively. Four studies reported significantly lower pain levels in the PENG block group compared with the control groups, measured differently in each study: 24 hours postoperatively, initial pain score in the PACU, mean score in the PACU, and highest score in the PACU. None of the studies found significantly worse outcomes in the PENG block group compared to the comparison group. Conclusions Systematic review of randomized controlled trials shows that patients undergoing hip arthroscopy who receive a PENG block do not consume fewer opioids for postoperative pain control than patients who do not receive the block. Level of Evidence Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Grace Tanguilig
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, U.S.A
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Wendell M.R. Heard
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
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Banks EM, Ayisi JA, Feroe AG, Alrayashi W, Yen YM, Novais EN, Hassan MM. Efficacy of regional anesthesia in hip preservation surgeries: a systematic review. J Hip Preserv Surg 2023; 10:87-103. [PMID: 37900889 PMCID: PMC10604060 DOI: 10.1093/jhps/hnad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 10/31/2023] Open
Abstract
The purpose of this study was to review the current literature on perioperative pain management in hip arthroscopy, periacetabular osteotomy and surgical hip dislocation. A systematic review of the literature published from January 2000 to December 2022 was performed. Selection criteria included published randomized controlled trials, prospective reviews and retrospective reviews of all human subjects undergoing hip preservation surgery. Exclusion criteria included case reports, animal studies and studies not reporting perioperative pain control protocols. Thirty-four studies included hip arthroscopy in which peripheral nerve blocks were associated with a significant reduction in pain score (P = 0.037) compared with general anesthesia alone. However, no pain control modality was associated with a significant difference in postanesthesia care unit opioid use (P = 0.127) or length of stay (P = 0.251) compared with general anesthesia alone. Falls were the most common complication reported, accounting for 37% of all complications. Five studies included periacetabular osteotomy and surgical hip dislocation in which peripheral nerve blocks were associated with an 18% reduction in pain on postoperative Day 2, a 48% reduction in cumulative opioid use on postoperative Day 2 and a 40% reduction in hospital stay. Due to the low sample size of the periacetabular osteotomy and surgical hip dislocation studies, we were unable to determine the significant difference between the means. Due to significant between-study heterogeneity, additional studies with congruent outcome measures need to be conducted to determine the efficacy of regional anesthesia in hip arthroscopy, periacetabular osteotomy and surgical hip dislocation.
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Affiliation(s)
- Evan M Banks
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave Suite R200, Minneapolis, MN 55454, USA
| | - Jake A Ayisi
- Boston University Graduate Medical Sciences, Boston University School of Medicine, 72 East Concord St., L-317, L309, Boston, MA 02118, USA
| | - Aliya G Feroe
- Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Walid Alrayashi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Mahad M Hassan
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave Suite R200, Minneapolis, MN 55454, USA
- Tria Orthopedic Center, 8100 Northland Dr., Bloomington, Minneapolis, MN 55431, USA
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Daoust R, Paquet J, Chauny JM, Williamson D, Huard V, Arbour C, Emond M, Rouleau D, Cournoyer A. Impact of vitamin C on the reduction of opioid consumption after an emergency department visit for acute musculoskeletal pain: a double-blind randomised control trial protocol. BMJ Open 2023; 13:e069230. [PMID: 37225265 PMCID: PMC10230879 DOI: 10.1136/bmjopen-2022-069230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Recent evidence has shown that vitamin C has some analgesic properties in addition to its antioxidant effect and can, therefore, reduce opioid use during recovery time. Vitamin C analgesic effect has been explored mostly during short-term postoperative context or in disease-specific chronic pain prevention, but never after acute musculoskeletal injuries, which are often seen in the emergency department (ED). The protocol's primary aim is to compare the total morphine 5 mg pills consumed during a 2-week follow-up between patients receiving vitamin C or a placebo after ED discharge for an acute musculoskeletal pain complaint. METHODS AND ANALYSIS We will conduct a two-centre double-blind randomised placebo-controlled trial with 464 participants distributed in two arms, one group receiving 1000 mg of vitamin C two times a day for 14 days and another one receiving a placebo. Participants will be ≥18 years of age, treated in ED for acute musculoskeletal pain present for less than 2 weeks and discharged with an opioid prescription for home pain management. Total morphine 5 mg pills consumed during the 2-week follow-up will be assessed via an electronic (or paper) diary. In addition, patients will report their daily pain intensity, pain relief, side effects and other types of pain medication or other non-pharmacological approach used. Three months after the injury, participants will also be contacted to evaluate chronic pain development. We hypothesised that vitamin C, compared with a placebo, will reduce opioid consumption during a 14-day follow-up for ED discharged patients treated for acute musculoskeletal pain. ETHICS AND DISSEMINATION This study has received approval from the Ethics Review Committee from the 'Comité d'éthique de la recherche du CIUSSS du Nord-de-l'Île-de-Montréal (No 2023-2442)'. Findings will be disseminated through scientific conferences and peer-reviewed journal publication. The data sets generated during the study will be available from the corresponding author on reasonable request. TRIAL REGISTRATION NUMBER NCT05555576 ClinicalTrials.Gov PRS.
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Affiliation(s)
- Raoul Daoust
- Département de Médecine Familiale et de Médecine d'Urgence, Université de Montréal, Montreal, Quebec, Canada
- Study Center in Emergency Medicine, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Jean Paquet
- Study Center in Emergency Medicine, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
| | - Jean-Marc Chauny
- Département de Médecine Familiale et de Médecine d'Urgence, Université de Montréal, Montreal, Quebec, Canada
- Study Center in Emergency Medicine, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
| | - David Williamson
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Vérilibe Huard
- Département de Médecine Familiale et de Médecine d'Urgence, Université de Montréal, Montreal, Quebec, Canada
- Study Center in Emergency Medicine, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Caroline Arbour
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
| | - Marcel Emond
- Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Dominique Rouleau
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Alexis Cournoyer
- Département de Médecine Familiale et de Médecine d'Urgence, Université de Montréal, Montreal, Quebec, Canada
- Study Center in Emergency Medicine, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
- Centre de Recherche, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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Kunze KN, Kay J, Pareek A, Dahmen J, Chahla J, Nho SJ, Williams RJ, de Sa D, Karlsson J. A guide to appropriately planning and conducting meta-analyses: part 3. Special considerations-the network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07419-7. [PMID: 37193822 DOI: 10.1007/s00167-023-07419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023]
Abstract
The meta-analysis has become one of the predominant studies designs in orthopaedic literature. Within recent years, the network meta-analysis has been implicated as a powerful approach to comparing multiple treatments for an outcome of interest when conducting a meta-analysis (as opposed to two competing treatments which is typical of a traditional meta-analysis). With the increasing use of the network meta-analysis, it is imperative for readers to possess the ability to independently and critically evaluate these types of studies. The purpose of this article is to provide the necessary foundation of knowledge to both properly conduct and interpret the results of a network meta-analysis.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA.
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Patel V, Patel V, Abdallah F, Whelan D, Bansal S, Gabra M, Brull R. The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. Reg Anesth Pain Med 2022; 47:rapm-2022-103743. [PMID: 36008086 DOI: 10.1136/rapm-2022-103743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and safety of a preoperative PENG block among patients undergoing ambulatory hip arthroscopic surgery where systemic analgesia is the gold standard. METHODS We conducted a single-center, retrospective pragmatic exploratory cohort study of consecutive outpatient hip arthroscopic surgery cases from January 2017 to March 2019. We identified 164 cases in which patients received general anesthesia with or without a preoperative PENG block. The primary analgesic outcome measures were time to first postoperative analgesic request, intraoperative and postoperative opioid consumption (intravenous morphine equivalent), and postoperative pain severity (visual analog scale 10 cm scale ranging from 0=no pain to 10=severe pain) in hospital. Secondary outcomes included duration of stay in the postanesthesia care unit, opioid-related side effects, time to discharge readiness, and block-related complications. RESULTS Seventy-five cases received a preoperative PENG block and 89 cases received systemic analgesia alone. The addition of a PENG block reduced intraoperative (6.6 mg vs 7.5 mg, difference: 0.9 mg; 95% CI 0.2 to 1.7; p=0.01) and postoperative (10.7 mg vs 13.9 mg, difference: 3.2 mg; 95% CI 0.9 to 5.5; p=0.01) intravenous morphine consumption, as well as the mean (3.5 vs 4.2, difference: 0.7; 95% CI 0.1 to 1.3; p=0.03) and highest (5.5 vs 6.5, difference: 1.0; 95% CI 0.2 to 1.7; p=0.02) postoperative pain severity scores in hospital. The PENG block did not prolong the time to first analgesic request (15.8 min vs 12.3 min, difference: 3.5 min; 95% CI -9.0 to 2.0; p=0.23). Fewer patients in the PENG group experienced postoperative nausea and vomiting compared with systemic analgesia alone (36% vs 52%, OR 1.9; 95% CI 1.0 to 3.6; p=0.02), while the PENG block expedited discharge readiness (165.0 min vs 202.8 min, difference: 37.8 min; 95% CI 2.9 to 72.3; p=0.04). No block-related complications were noted in any patient. DISCUSSION Based on our retrospective dataset, this pragmatic exploratory cohort study suggests that a preoperative PENG block is associated with questionable improvements in postoperative in-hospital analgesic outcomes which may or may not prove to be clinically relevant when compared with systemic analgesia alone for patients undergoing hip arthroscopic surgery. This small signal should be investigated in a prospective randomized trial.
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Affiliation(s)
- Vanisha Patel
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vivesh Patel
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Faraj Abdallah
- Department of Anesthesiology and Pain Medicine, Women's College Research Institute, Toronto, Ontario, Canada
| | - Daniel Whelan
- Department of Orthopaedic Sport Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Department of Orthopaedic Sport Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Shikha Bansal
- Department of Anesthesia, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Martino Gabra
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Richard Brull
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, Toronto, Ontario, Canada
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Kollmorgen R, Umerani M, Gollon J, Fleming D, Lewis B, Harris J, Ellis T. Preoperative Pericapsular Nerve Group Block Results in Less Pain, Decreased Narcotic Use, and Quicker Discharge Time Than No Block in Patients Who Were Surgically Treated for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2022; 4:e1617-e1621. [PMID: 36312702 PMCID: PMC9596865 DOI: 10.1016/j.asmr.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Robert Kollmorgen
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, Hip Preservation, Fresno, California
- Address correspondence to Robert Kollmorgen D.O., Department of Orthopaedic Surgery, University of California San Francisco, Fresno, Hip Preservation, 2823 Fresno St., Fresno, CA 93721.
| | - Maleehah Umerani
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, Hip Preservation, Fresno, California
| | | | - Derek Fleming
- Midwest Physician Anesthesia Services, Columbus, Ohio
| | - Brian Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Joshua Harris
- Houston Methodist Orthopedics & Sports Medicine, Outpatient Center, Houston, Texas, U.S.A
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Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine. J Am Acad Orthop Surg 2022; 30:535-542. [PMID: 35576538 DOI: 10.5435/jaaos-d-21-01228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for multimodal pain control after surgery. These medications work by selective or nonselective inhibition of cyclooxygenase, which has downstream effects on thromboxanes, prostaglandins, and prostacyclins. Clinical studies have shown beneficial effects for alleviating pain and reducing opioid consumption after surgery. Within hip arthroscopy, there is evidence that postoperative NSAIDs can also reduce the risk of symptomatic heterotopic bone formation. However, preclinical and animal studies have raised concern over the effect of NSAIDs on bone and soft-tissue healing. In addition, selective and nonselective cyclooxygenase 2 inhibitors may have different safety profiles regarding postoperative soft-tissue healing. The purpose of this review was to outline the mechanisms of action, efficacy, and effect on soft-tissue healing of postoperative NSAIDs and to provide evidence-based recommendations for appropriate use.
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Paul RW, Szukics PF, Brutico J, Tjoumakaris FP, Freedman KB. Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e721-e746. [PMID: 35494281 PMCID: PMC9042766 DOI: 10.1016/j.asmr.2021.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Patrick F. Szukics
- Rowan University School of Osteopathic Medicine, Department of Orthopaedic Surgery, Stratford, New Jersey, U.S.A
| | - Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
- Address correspondence to Kevin B. Freedman, M.D., Rothman Orthopaedic Institute, Thomas Jefferson University, 825 Old Lancaster Rd., Suite 200, Bryn Mawr, PA, 19010, U.S.A.
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Smith JRH, Kraeutler MJ, Keeling LE, Scillia AJ, McCarty EC, Mei-Dan O. Fascia Iliaca Block for Postoperative Pain Control After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials. Am J Sports Med 2021; 49:4042-4049. [PMID: 33710936 DOI: 10.1177/0363546521996713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various analgesic modalities have been used to improve postoperative pain in patients undergoing hip arthroscopy. PURPOSE To systematically review the literature to compare the efficacy of the fascia iliaca block (FIB) with that of other analgesic modalities after hip arthroscopy in terms of postoperative pain scores and analgesic consumption. STUDY DESIGN Systematic review. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase up to April 2020 to identify randomized controlled trials that compared postoperative pain and analgesic consumption in patients after hip arthroscopy with FIB versus other pain control modalities. The search phrase used was "hip arthroscopy fascia iliaca randomized." Patients were evaluated based on postoperative pain scores and total postoperative analgesic consumption. RESULTS Five studies (3 level 1, 2 level 2) were identified that met inclusion criteria, including 157 patients undergoing hip arthroscopy with FIB (mean age, 38.3 years; 44.6% men) and 159 patients among the following comparison groups: lumbar plexus block (LPB), intra-articular ropivacaine (IAR), local anesthetic infiltration (LAI), saline placebo, and a no-block control group (overall mean age, 36.2 years; 36.5% men). No significant differences in pain scores were reported in the postanesthesia care unit (PACU) between the FIB and LPB (3.4 vs 2.9; P = .054), IAR (7.7 vs 7.9; P = .72), control group (no FIB: 4.1 vs 3.8; P = .76); or saline placebo (difference, -0.2 [95% CI, -1.1 to 0.7]). One study reported significantly higher pain scores at 1 hour postoperation in the FIB group compared with the LAI group (5.5 vs 3.4; P = .02). Another study reported significantly greater total analgesic consumption (in morphine equivalent dosing) in the PACU among the FIB group compared with the LPB group (20.8 vs 17.0; P = .02). No significant differences were observed in total PACU analgesic consumption between FIB and other analgesic modalities. CONCLUSION In patients undergoing hip arthroscopy, the FIB does not appear to demonstrate superiority to other forms of analgesics in the immediate postoperative period. Therefore, it is not recommended as a routine form of pain control for these procedures.
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Affiliation(s)
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Laura E Keeling
- Department of Orthopaedics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Cleland TL, Gharib M, Williams R, Jain NB. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2021; 103:2063-2069. [PMID: 34546999 DOI: 10.2106/jbjs.21.00868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Travis L Cleland
- Department of Physical Medicine and Rehabilitation, Crystal Clinic Orthopaedic Center, Akron, Ohio
| | - Mahmood Gharib
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Reed Williams
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Hassan MM, Rahman OF, Hussain ZB, Burgess SL, Yen YM, Kocher MS. Opioid overprescription in adolescents and young adults undergoing hip arthroscopy. J Hip Preserv Surg 2021; 8:75-82. [PMID: 34567603 PMCID: PMC8460166 DOI: 10.1093/jhps/hnab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/03/2021] [Indexed: 12/16/2022] Open
Abstract
Few studies have examined factors related to the increased consumption of opioids after hip arthroscopy in adolescents and young adults. This study sought to determine prescription patterns following hip arthroscopy in this population, and to determine clinical or surgical factors associated with increased post-operative opioid use. Daily post-operative opioid intake was obtained from pain-control logbooks of adolescents and young adults who underwent hip arthroscopy between January 2017 and 2020. Study outcomes were defined as the median total number of opioid tablets consumed, total days opioids were consumed, mean daily opioid consumption and the ratio of opioids prescribed post-operatively to consumed. Clinical and surgical factors were analyzed to determine any association with opioid consumption. Fifty-eight (20%) patients returned completed logbooks. Most patients (73%) were prescribed 30 oxycodone tablets. The median number of tablets consumed was 7 (range 0–41) over a median duration of 7 days (range 1–22). The median ratio of tablets consumed to prescribed was 20%. Increasing patient age at surgery was associated with increased total number of tablets consumed (r = 0.28, P = 0.04) and to the ratio of tablets consumed to prescribed (r = 0.30, P = 0.03). Patients who were prescribed more than 30 tablets consumed on average 7.8 more tablets than patients prescribed fewer (P = 0.003). Patients who underwent regional anesthesia consumed tablets for longer compared with those who did not (median, 10 versus 4 days; P = 0.03). After undergoing hip arthroscopy, adolescents and young adult patients are commonly overprescribed opioids, consuming on average only one-fifth of the tablets prescribed.
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Affiliation(s)
- Mahad M Hassan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Omar F Rahman
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 100 E 77th St, New York, NY 10075, USA
| | - Zaamin B Hussain
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Orthopaedic Surgery, Emory University School of Medicine, 1364 E Clifton Rd NE, Atlanta, GA 30322, USA
| | - Stephanie L Burgess
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost. Plast Reconstr Surg 2021; 147:978e-989e. [PMID: 34019509 DOI: 10.1097/prs.0000000000007987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigates the associations between local anesthesia practice and perioperative complication, length of stay, and hospital cost for palatoplasty in the United States. METHODS Patients undergoing cleft palate repair between 2004 and 2015 were abstracted from the Pediatric Health Information System database. Perioperative complication, length of stay, and hospital cost were compared by local anesthesia status. Multiple logistic regressions controlled for patient demographics, comorbidities, and hospital characteristics. RESULTS Of 17,888 patients from 49 institutions who met selection criteria, 8631 (48 percent), 4447 (25 percent), and 2149 (12 percent) received epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone, respectively. The use of epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with decreased perioperative complication [adjusted OR, 0.75 (95 percent CI, 0.61 to 0.91) and 0.63 (95 percent CI, 0.47 to 0.83); p = 0.004 and p = 0.001, respectively]. Only bupivacaine- or ropivacaine-alone recipients experienced a significantly reduced risk of prolonged length of stay on adjusted analysis [adjusted OR, 0.71 (95 percent CI, 0.55 to 0.90); p = 0.005]. Risk of increased cost was reduced in users of any local anesthetic (p < 0.001 for all). CONCLUSIONS Epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with reduced perioperative complication following palatoplasty, while only the latter predicted a decreased postoperative length of stay. Uses of epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone were all associated with decreased hospital costs. Future prospective studies are warranted to further delineate the role of local anesthesia in palatal surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Bovonratwet P, Boddapati V, Nwachukwu BU, Bohl DD, Fu MC, Nho SJ. Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission. Knee Surg Sports Traumatol Arthrosc 2021; 29:1385-1391. [PMID: 32705297 DOI: 10.1007/s00167-020-06170-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the association between operative duration and short-term complications as well as overnight hospital admission following hip arthroscopy. METHODS Hip arthroscopy cases from 2006 to 2016 were retrieved from the National Surgical Quality Improvement Program registry, which prospectively collects 30-day postoperative complications. Patients were stratified into the following groups based on procedure length: group 1 (< 60 min), group 2 (60-120 min), and group 3 (> 120 min). Preoperative characteristics were compared across the cohorts. Multivariate regressions were used to compare complication rates and overnight hospital admission between the three groups. Independent risk factors for overnight hospital admission were characterized. RESULTS A total of 2129 hip arthroscopy cases were identified. Average operative duration was 99.3 ± 55.7 min. As operative time increased, patients were more likely to be younger, male, and had lower American Society of Anesthesiologists (ASA) class (p < 0.001). Body mass index and comorbidity profiles were similar across the patient cohorts, with the exception of hypertension being more prevalent in the shorter operative time cohort (p < 0.001). Patients in group 3 were more likely to stay overnight in the hospital (26.0%) compared to patients in groups 1 (7.7%) and 2 (10.9%), p < 0.001). All postoperative complication rates were otherwise similar between the cohorts. Independent risk factors for overnight hospital admission included increasing operative time (most notably > 120 min relative to < 60 min, relative risk [RR] = 3.53, 95% CI 2.50-5.00, p < 0.001) and increasing ASA classification (most notably ASA III or IV relative to ASA I, RR = 1.64, 95% CI 1.18-2.27; p = 0.013). CONCLUSIONS Increasing operative duration was not associated with increased postoperative complications following hip arthroscopy. However, patients were more than three times likely to stay in the hospital overnight if their surgery was longer than 120 min, relative to cases that were less than 60 min. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
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Rossi MJ. Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome. Arthroscopy 2021; 37:1573-1576. [PMID: 33896509 DOI: 10.1016/j.arthro.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
Opioid research in sports medicine and arthroscopic surgery has exploded in the last few years. The literature definitively shows that preoperative opioid usage-in so-called opioid exposed, tolerant, and familiar patients-increases postoperative usage, readmission rates, and medical complications, yielding poorer outcome. Strategies to combat the deleterious effects of preoperative opioid use should be used to include ownership and acknowledgment of the problem, adherence to opioid prescribing protocols, and use of a multimodal anesthesia program that can mitigate the adverse effects by limiting abuse and preventing potential poor outcome. Adding patient education programs to change patient modifiable risk factors shows promise while simultaneously optimizing appropriate patient expectations that are linked to increased outcome. Thus, opioid mitigation, sparing, or altogether avoidance through improved education programs and opioid prescribing protocols will likely be the future of sports medicine and arthroscopic surgery to optimize patient outcome.
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Richardson MA, Park W, Echternacht SR, Bell DE. Altmetric Attention Score: Evaluating the Social Media Impact of Burn Research. J Burn Care Res 2021; 42:1181-1185. [PMID: 33528573 DOI: 10.1093/jbcr/irab026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Traditional measures of scholarly impact (i.e., impact factor, citation rate) do not account for the role of social media in knowledge dissemination. The Altmetric Attention Score (AAS) tracks the online sharing activity of articles on platforms such as Twitter and Facebook. All 285 original scientific articles published in Journal of Burn Care & Research and Burns from January to December 2017 were obtained from official journal websites. Article characteristics extracted include: AAS; number of Twitter, Facebook, and news outlet mentions; subject of study and study design; number of citations; number of authors and academic institutions; and others. The average AAS for all articles was 6.1 (SD: 48; Range: 0 to 611) in which 156 (55%) of those had Twitter mentions. The mean AAS for Journal of Burn Care & Research and Burns were 7.7 (SD: 54; Range: 0 to 536) and 5.3 (SD: 45; Range: 0 to 611), respectively. There was a weak, positive correlation between AAS and citation count for all articles (ρ = 0.12; p = 0.049), and this finding was consistent for Journal of Burn Care & Research (ρ = 0.21; p = 0.039) and Burns (ρ = 0.15; p = 0.038) individually. The weak correlation between the two metrics supports that AAS and citation count capture the attention of different audiences. In addition, studies discussing skin grafting were associated with higher average AAS (β: 29 [95% CI: 4.2 to 54]; p = 0.022). Overall, our findings support using both AAS and traditional bibliometrics to assess article impact.
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Affiliation(s)
| | - Won Park
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Derek E Bell
- University of Rochester Medical Center, Kessler Burn and Trauma Center, Rochester, NY
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Garcia FL, Williams BT, Maheshwer B, Bedi A, Wong IH, Martin HD, Nho SJ, Chahla J. Pain management practice patterns after hip arthroscopy: an international survey. J Hip Preserv Surg 2020; 7:537-546. [PMID: 33948210 PMCID: PMC8081420 DOI: 10.1093/jhps/hnaa050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/16/2022] Open
Abstract
Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.
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Affiliation(s)
- Flávio L Garcia
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA.,Department of Orthopaedic Surgery, Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil, Rua Visconde de Pirajá, 407 Rio de Janeiro, RJ, 22410-003, Brazil.,Department of Orthopaedics and Anesthesiology, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, Avenida Bandeirantes, 3900 Ribeirão Preto, SP, 14049-900, Brazil
| | - Brady T Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Bhargavi Maheshwer
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, 1500 E Medical Center Drive Ann Arbor, MI, 48109, USA
| | - Ivan H Wong
- Department of Surgery, Dalhousie University, Halifax, 6299 South St Halifax, NS, B3H 4R2, Nova Scotia, Canada
| | - Hal D Martin
- Hip Preservation, aylor University Medical Center, 411 N Washington Ave, Suite 7300 Dallas, TX, 75246, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
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Abstract
Approximately one-third of patients undergoing arthroscopic hip preservation surgery for femoroacetabular impingement syndrome and labral tears are on preoperative opioid medications. The single most important predictor for prolonged chronic postoperative opioid use is preoperative use. Despite the well-documented high success rates in nonarthritic, nondysplastic individuals undergoing hip arthroscopy, up to half of those individuals on preoperative opioids may still be on opioids at 1 to 2 years of follow-up. Mental wellness disorders (e.g., depression, anxiety, substance abuse) significantly impact both pre- and postoperative pain, function, and activity in nearly all joint and general health outcome measures. Multimodal pain management strategies have shown excellent reduction in perioperative opioid utilization. Intraoperative techniques should strive for comprehensive true hip preservation: labral repair, accurate cam/pincer morphology correction, and routine capsular management. Objective, quantitative pain threshold and pain tolerance measurements may improve treatment decision-making, with better prediction of surgical outcomes. Future personalized health care may use a single individual's mu opioid receptor (OPRM-1 gene) and a number of other genetic markers for pain management to reduce the need for traditional opioid medications. Is opioid-free hip arthroscopy possible? Absolutely. Will the opioid epidemic end? Yes, but we have a lot of work to do.
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