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Amato PE, Winkelman AJ, Forster GL, Gwathmey FW. Regional Anesthesia for Hip Arthroscopy. Anesthesiol Clin 2024; 42:233-246. [PMID: 38705673 DOI: 10.1016/j.anclin.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Pain after hip arthroscopy can be severe, yet we lack a consensus method for non-narcotic analgesia. Here we describe anatomic elements of hip arthroscopy and our current understanding of the relevant sensory innervation as a prelude to the evaluation of locoregional analgesic techniques. Many regional nerve blocks and local anesthetic infiltration techniques are reviewed, including 2 newer ultrasound fascial plane blocks. Further study of targeted, motor-sparing approaches, either ultrasound-guided or under direct surgical visualization is needed.
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Affiliation(s)
- Peter E Amato
- Acute Pain Service, Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
| | - Andrew J Winkelman
- Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Grace L Forster
- Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, University of Virginia, 515 Ray C. Hunt Drive, Charlottesville, VA, 22908 USA
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2
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AlMutiri WA, AlMajed E, Alneghaimshi MM, AlAwadh A, AlSarhan R, AlShebel MN, AlMatrody RAM, Hadaddi R, AlTamimi R, Bin Salamah R, AlZelfawi LA, AlBatati SK, AlHarthi A, AlMazroa G, AlHossan AM. Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3194. [PMID: 38892904 PMCID: PMC11173339 DOI: 10.3390/jcm13113194] [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: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.
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Affiliation(s)
- Wijdan A. AlMutiri
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Ebtesam AlMajed
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Muath M. Alneghaimshi
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
| | - Afnan AlAwadh
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Reem AlSarhan
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Malak N. AlShebel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | | | - Rafa Hadaddi
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | - Reem AlTamimi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Rawan Bin Salamah
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Lama A. AlZelfawi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Saud K. AlBatati
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
| | - Alanood AlHarthi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Ghayda AlMazroa
- College of Medicine, Qassim University, Qassim 51452, Saudi Arabia;
| | - Abdullah M. AlHossan
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
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Kotlier JL, Fathi A, Kumaran P, Mayfield CK, Orringer M, Liu JN, Petrigliano FA. Demographic and Socioeconomic Patient Data Are Rarely Included in Randomized Controlled Trials for Femoral Acetabular Impingement and Hip Arthroscopy: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100901. [PMID: 38379603 PMCID: PMC10878849 DOI: 10.1016/j.asmr.2024.100901] [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: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To determine the rate of reporting for sociodemographic variables in randomized controlled trials (RCTs) investigating femoral acetabular impingement (FAI) and hip arthroscopy. Methods PubMed, Scopus, and Web of Science were queried for articles relating to FAI and hip arthroscopy. Articles included in final analysis were RCTs investigating operative management of FAI. Included RCTs were analyzed for reporting of age and sex or gender as well as the following sociodemographic variables: race, ethnicity, insurance status, income, housing status, work status, and education level in the results section or any section of the paper. Data was analyzed using χ2 and Fisher exact tests with significance defined as P < .05. Results Forty-eight RCTs were identified from 2011 to 2023. Age was reported in 48 of 48 (100%) of included papers; sex or gender was reported in 47 of 48 (97.9%). Reporting of sociodemographic variables in any section respectively was: race (7/48, 14.6%), ethnicity (4/48, 8.33%), insurance status (0/48, 0%), income (1/48, 2.08%), housing status (0/48, 0%), work status (3/48, 6.25%), and education (2/48, 4.17%). There was no significant difference for reporting demographic variables with respect to journal or year of publication (P = .666 and P = .761, respectively). Sociodemographic variables (9/48) were reported significantly less frequently than age and sex or gender (48/48) (P < .001). Conclusions This study found that sociodemographic variables in FAI and hip arthroscopy RCTs are reported with much lower frequency than age and sex or gender. These findings may demonstrate the need to include patient sociodemographic data in RCTs so that their results can be better generalized and applied to the appropriate patient population. Level of Evidence Level II, systematic review of level I and II evidence.
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Affiliation(s)
| | - Amir Fathi
- USC Keck School of Medicine, Los Angeles, California, U.S.A
| | - Pranit Kumaran
- USC Keck School of Medicine, Los Angeles, California, U.S.A
| | | | | | - Joseph N. Liu
- USC Keck School of Medicine, Los Angeles, California, U.S.A
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Kollmorgen R. Editorial Commentary: The Addition of the Pericapsular Nerve Group Block Leads to Reduced Pain Up to 24 Hours After Hip Arthroscopy. Arthroscopy 2024; 40:381-383. [PMID: 38296442 DOI: 10.1016/j.arthro.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 02/07/2024]
Abstract
Surgeons performing hip arthroscopy (HA) continue to look for solutions to address immediate postoperative pain and achieve a safe and efficient same-day discharge. Multiple studies have looked at modalities to achieve this, and we have learned that some methods are successful whereas others have a high-risk profile and should be avoided. The pericapsular nerve group (PENG) block is at the forefront of the literature. The PENG block is an easy-to-perform pericapsular nerve block that has been shown in prospective and retrospective studies to decrease acute postoperative pain. With modern ultrasound techniques, the PENG block has a short learning curve and acceptable patient safety profile. Other regional blocks have been extensively studied and are not without their drawbacks. Neuraxial anesthesia has shown decreased pain after HA but carries the risk of neuraxial complications and ambulatory discharge delay. Quadratus lumborum, lumbar plexus, and femoral nerve blocks can impact muscle strength and carry the risk of falls. Fascia iliaca blocks have shown the potential for increased pain and have been abandoned. The PENG block has been shown to be safe, but there are risks of inadvertent femoral nerve block if the probe or needle is out of plane. The PENG block does not seem to be the only answer to controlling post-HA pain but is one more weapon in our armamentarium to treat acute postoperative pain. Our current multimodal HA protocol consists of intravenous ketorolac, a PENG block, general endotracheal anesthesia, 4 mg of dexamethasone, 25 mg of ketamine at induction and 25 mg of ketamine slowly infused throughout the case, and post-free HA. We have a 100% same-day discharge rate, with no reported block complications and no groin complications, and for us, this method has proved to decrease the time to discharge.
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Scott EJ. Editorial Commentary: Hip Arthroscopy Pain Management With Surgeon-Administered Pericapusular Injection Is Fast, Safe, Inexpensive, and Effective. Arthroscopy 2023; 39:2464-2465. [PMID: 37981388 DOI: 10.1016/j.arthro.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 11/21/2023]
Abstract
Regional pain management after hip arthroscopy is challenging. The hip capsule alone has a complex and highly variable innervation, including contributions from articular branches of the femoral, obturator, accessory obturator, accessory femoral, superior gluteal, accessory superior gluteal, inferior gluteal, sciatic, and posterior femoral cutaneous nerves, nerve to the quadratus femoris, as well as a direct supply from the lumbosacral plexus. Thus, it is unrealistic to expect a traditional peripheral nerve block, including blocks of the proximal lumbar plexus, femoral nerve, and fascia iliaca region to provide thorough hip analgesia without inducing quadriceps weakness that could result in a patient experiencing a fall during the postoperative period. In addition, newer, sensory-only blocks, such as quadratus lumborum or pericapsular nerve group blocks, have not been shown to be superior to simple pericapsular injection (PCI). Hip arthroscopy pain management using surgeon administered PCI is fast, safe, inexpensive, and effective. While not perfect, PCI is the best option among current choices.
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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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Farag A, Hendi NI, Diab RA. Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis. J Anesth 2023; 37:138-153. [PMID: 36342537 PMCID: PMC9870839 DOI: 10.1007/s00540-022-03129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Perioperative pain management related to hip surgical procedures is challenging. Pericapsular nerve group (PENG) block is a novel technique that is assumed to provide better analgesia in addition to its post-operative motor-sparing effect. In this review, we aim to assess the safety and efficacy of PENG block on pain management in patients undergoing hip surgeries. Fifteen clinical trials with a total of 837 patients were included. Pain scores favored PENG group when compared to FICB group (fascia iliaca compartment block) or analgesics-only group, but the difference could only be detected in the early post-operative period. Afterward, it seems to lose its superiority, and no difference could be detected. In addition, cumulative opioid consumption favored PENG group at 24 h but not at 48 h. Regarding patients' satisfaction, our analysis showed results favoring PENG group, but there was no difference in time to first opioid or length of hospital stay. The incidence of vomiting was lower in PENG, but there was no difference in the incidence of nausea, pruritis, and dizziness. PENG provides better analgesia and lower opioid consumption in the initial post-operative period. Current evidence is not enough, and further high-quality randomized controlled trials with larger sample sizes are required.
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Affiliation(s)
- Ahmed Farag
- Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
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Yusupov A, Fasulo SM, Dávila Castrodad IM, Kraeutler MJ, Scillia AJ. Improved Pain and Perioperative Outcomes After Hip Arthroscopy With the Pericapsular Nerve Group Block. Arthroscopy 2023; 39:293-297. [PMID: 36183920 DOI: 10.1016/j.arthro.2022.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To compare early postoperative pain in patients undergoing hip arthroscopy with versus without the pericapsular nerve group (PENG) block. METHODS A retrospective chart review of prospectively collected data was performed to identify patients who underwent hip arthroscopy at a single institution between May 2019 and October 2021. Patients were included if they received general anesthesia and were opioid naive. Patients who received the PENG block were compared with patients who did not. Opioid, benzodiazepine, and antiemetic medication administration was recorded both intraoperatively and for the duration of the patient's stay in the postanesthesia care unit (PACU). Opioids administered were converted to morphine milligram equivalents (MMEs). Pain was assessed with a visual analog scale. Time to discharge (in minutes) and complications were recorded. RESULTS A total of 53 patients were identified for inclusion, of whom 28 received the PENG block and 25 did not. Opioid consumption was significantly lower in the PENG block group both intraoperatively (16.9 ± 14.1 MMEs vs 40.6 ± 18.3 MMEs, P < .001) and in the PACU (14.4 ± 11.4 MMEs vs 31.2 ± 20.1 MMEs, P < .001). The highest recorded PACU pain score was significantly greater in the no-PENG block group (7.0 ± 1.9 vs 5.3 ± 2.1, P = .004). Within the PENG block group, fewer patients required antiemetics (0 vs 4, P = .043). There was a greater time to discharge in the no-PENG block group (161 ± 50 minutes vs 129 ± 34 minutes, P = .008). No complications, including postoperative falls, were noted in either group. CONCLUSIONS The PENG block improves perioperative outcomes by decreasing pain, opioid consumption, time to discharge, antiemetic requirements, and benzodiazepine requirements after hip arthroscopy. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Albert Yusupov
- Morristown Medical Center, Morristown, New Jersey, U.S.A
| | - Sydney M Fasulo
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Iciar M Dávila Castrodad
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
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9
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Huda AU, Ghafoor H. The Use of Pericapsular Nerve Group (PENG) Block in Hip Surgeries Is Associated With a Reduction in Opioid Consumption, Less Motor Block, and Better Patient Satisfaction: A Meta-Analysis. Cureus 2022; 14:e28872. [PMID: 36105907 PMCID: PMC9449447 DOI: 10.7759/cureus.28872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
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10
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Amato PE, Winkelman AJ, Forster GL, Gwathmey FW. Regional Anesthesia for Hip Arthroscopy. Clin Sports Med 2022; 41:233-246. [PMID: 35300837 DOI: 10.1016/j.csm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pain after hip arthroscopy can be severe, yet we lack a consensus method for non-narcotic analgesia. Here we describe anatomic elements of hip arthroscopy and our current understanding of the relevant sensory innervation as a prelude to the evaluation of locoregional analgesic techniques. Many regional nerve blocks and local anesthetic infiltration techniques are reviewed, including 2 newer ultrasound fascial plane blocks. Further study of targeted, motor-sparing approaches, either ultrasound-guided or under direct surgical visualization is needed.
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Affiliation(s)
- Peter E Amato
- Acute Pain Service, Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
| | - Andrew J Winkelman
- Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Grace L Forster
- Department of Anesthesiology, University of Virginia Health System, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, University of Virginia, 515 Ray C. Hunt Drive, Charlottesville, VA, 22908 USA
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Scanaliato JP, Green CK, Salfiti CE, Wolff AB. Hip Labral Reconstruction: Techniques and Outcomes. Curr Rev Musculoskelet Med 2021; 14:340-350. [PMID: 34799843 DOI: 10.1007/s12178-021-09733-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW With increased understanding of the biomechanical function of the acetabular labrum, more attention has been directed towards surgical techniques that preserve or restore normal joint anatomy. While labral repair has been shown to produce superior outcomes to labral debridement, repair is not always possible in the setting of severe labral intrasubstance tearing or deficiency. These patients were previously left without suitable arthroscopic treatment options. RECENT FINDINGS Labral reconstruction is an emerging procedure that has been shown to offer promising outcomes for traditionally difficult-to-treat hip pathology. Short- and mid-term follow-up studies have consistently demonstrated significant improvement in patient-reported outcomes, function, and patient satisfaction postoperatively, often despite less favorable preoperative characteristics. Labral reconstruction is a viable arthroscopic treatment option that has been shown to reliably produce clinically meaningful results in patients with severe labral pathology that is not amenable to repair/refixation or augmentation.
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Affiliation(s)
- J P Scanaliato
- William Beaumont Army Medical Center/Texas Tech Health Sciences Center, El Paso, TX, USA.
| | - C K Green
- The George Washington University School of Medicine, Washington, DC, USA
| | - C E Salfiti
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | - A B Wolff
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
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12
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August G, Johnson AH, Turcotte JJ, Petre BM. The impact of fascia iliaca nerve blockade on early postoperative pain and recovery after hip arthroscopy for femoroacetabular impingement syndrome. J Hip Preserv Surg 2021; 8:255-260. [PMID: 35414951 PMCID: PMC8994112 DOI: 10.1093/jhps/hnab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Fascia iliaca nerve blockade (FIB) has been previously described as an effective technique for reducing postoperative pain and opioid consumption after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesize that an FIB will significantly reduce opioid consumption, pain scores and recovery time in our population. A retrospective observational study of 326 consecutive patients undergoing hip arthroscopy for FAIS at a single institution was performed. Patients were classified based on whether or not they received an FIB. Patient demographics, surgical details, medication details and 6-month postoperative outcomes were collected. The primary endpoint was the amount of narcotics required intraoperatively and in the postanesthesia care unit (PACU). Of the 326 patients included in the study, 37 received an FIB. No differences in sex, age or other surgical details were observed between groups. Patients receiving an FIB were more likely to receive celecoxib (P < 0.001), pregabalin (P = 0.001) and methocarbamol (P = 0.002). The FIB group received lower doses of narcotics intraoperatively (P = 0.001), postoperatively (P < 0.001) and in total (P < 0.001). The FIB group also self-reported lower first pain scores upon arrival to PACU (P = 0.001) and experienced shorter PACU recovery times (P < 0.001). After controlling for differences between groups, patients who received an FIB required significantly lower amounts of narcotics, had shorter PACU times and lower first PACU pain score than those who did not (P < 0.001). No differences in complication rates were noted between groups. The use of FIB resulted in lower pain scores, reduced recovery time and decreased early postoperative narcotic requirements for patients undergoing hip arthroscopy for femoroacetabular impingement. Further study is required to validate these findings and determine the optimal approach to regional analgesia in this patient population.
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Affiliation(s)
- Grant August
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, USA
| | - Andrea H Johnson
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, USA
| | - Justin J Turcotte
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, USA
| | - Benjamin M Petre
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, USA
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Brioschi FA, Gioeni D, Lazzarini E, Del Prete G, Bronzo V, Jacchetti A, Carotenuto AM. Clinical effects of preemptive intra-articular lidocaine, dexmedetomidine and lidocaine-dexmedetomidine administration in dogs undergoing arthroscopy. Vet J 2021; 276:105730. [PMID: 34391917 DOI: 10.1016/j.tvjl.2021.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
This study investigated the perioperative effects of preemptive intra-articular lidocaine (L group), dexmedetomidine (D group) and lidocaine-dexmedetomidine (LD group) in dogs. Physiological variables were intraoperatively recorded at 5 min intervals starting from baseline (5 min before intra-articular injection). If nociception occurred, IV fentanyl was administered. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale. Twenty-four dogs (eight in each group) were included in this prospective, randomized, masked clinical study. In the LD group, systolic arterial pressure significantly increased at T10 (P = 0.027), T15 (P = 0.021) and T20 (P = 0.022), compared with baseline. In the D and LD groups, mean arterial pressure significantly increased at T10 (P = 0.022; 0.024), T15 (P = 0.024; 0.09) and T20 (P = 0.019; 0.021), compared with baseline and diastolic arterial pressure significantly increased at T10 (P = 0.026; 0.047), T15 (P = 0.021; 0.023), T20 (P = 0.011; 0.012) and T25 (P = 0.019; 0.027), compared with baseline. In the LD group, heart rate significantly decreased at T5 (P = 0.031), T10 (P = 0.026) and T15 (P = 0.034), compared with baseline. Atrioventricular blocks appeared more frequently in the LD group than in L and D groups (P = 0.002). Group L received more fentanyl than the D and LD groups (P = 0.03). No differences in postoperative pain score were detected (P = 0.121). These findings suggested systemic absorption of intra-articular dexmedetomidine. Intra-articular lidocaine-dexmedetomidine was associated with a greater incidence of atrioventricular blocks. Intra-articular dexmedetomidine, alone and combined with lidocaine, provided better intraoperative analgesia than lidocaine in dogs undergoing arthroscopy, although the 12 h postoperative analgesic effect of the three treatments was similar.
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Affiliation(s)
- F A Brioschi
- Ospedale Veterinario San Francesco, Milano, 20148, Italy.
| | - D Gioeni
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - E Lazzarini
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - G Del Prete
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - V Bronzo
- Department of Veterinary Medicine, Università degli Studi di Milano, Milano, 20133, Italy
| | - A Jacchetti
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
| | - A M Carotenuto
- Ospedale Veterinario San Francesco, Milano, 20148, Italy
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Scanaliato JP, Christensen D, Polmear MM, Salfiti C, Gaspar PS, Wolff AB. The Interface of Surgical and Anesthesiological Postoperative Analgesic Regime: Pericapsular Injection Versus Lumbar Plexus Block: Response. Am J Sports Med 2021; 49:NP46-NP47. [PMID: 34259603 DOI: 10.1177/03635465211023746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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15
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Hæstrup DS, Therkelsen ASN, Reisbøl S, Hansen CK, Børglum J, Nielsen MV. The Interface of Surgical and Anesthesiological Postoperative Analgesic Regime: Pericapsular Injection Versus Lumbar Plexus Block: Letter to the Editor. Am J Sports Med 2021; 49:NP45-NP46. [PMID: 34259602 DOI: 10.1177/03635465211023747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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