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Bourgeault-Gagnon Y, Abdel Khalik H, Patel M, Simunovic N, Ayeni OR. Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713876 DOI: 10.1002/ksa.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study. METHODS Opioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage state that may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively. RESULTS A total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27-42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34-4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90-8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25-39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25-4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60-32.6, p < 0.001). CONCLUSION Preoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco use and more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoan Bourgeault-Gagnon
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mansi Patel
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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2
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Kazum E, Rath E, Shlaifer A, Sharfman ZT, Martin HD, Eizenberg G, Reider E, Amar E. Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade. Hip Int 2022; 32:265-270. [PMID: 32866047 DOI: 10.1177/1120700020950247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. METHODS 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. RESULTS Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. CONCLUSIONS This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.
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Affiliation(s)
- Efi Kazum
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of MedicineBronx, NY, USA
| | - Hal D Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
| | - Gilad Eizenberg
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeny Reider
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Beck EC, Nwachukwu BU, Drager J, Jan K, Rasio J, Krishnamoorthy VP, Nho SJ. Prolonged Postoperative Opioid Use After Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum 2-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211038933. [PMID: 34888387 PMCID: PMC8649101 DOI: 10.1177/23259671211038933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The association between prolonged postoperative opioid use on outcomes after hip preservation surgery is not known. Purpose: To compare minimum 2-year patient-reported outcomes (PROs) between patients who required ≥1 postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) versus patients who did not require a refill and to identify preoperative predictors for patients requiring ≥1 postoperative opioid refill. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent arthroscopic surgery for FAIS between January 2012 and January 2017 were analyzed. Multivariate regression analysis was performed to classify patient and radiographic variables as predictive of requiring ≥1 opioid prescription refill after surgery. Patients completed the following PROs preoperatively and at 2-year follow-up: Hip Outcome Score— Activities of Daily Living subscale (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and 100-point visual analog scale (VAS) for pain and satisfaction. Scores were compared between patients needing additional prescription opioids and those who did not. Results: A total of 775 patients, of whom 141 (18.2%) required ≥1 opioid prescription refill, were included in the analysis. Patients requiring opioid refills had significantly lower 2-year postoperative PRO scores compared with patients not requiring refills: HOS-ADL (79.9 ± 20.3 vs 88.7 ± 14.9), HOS-SS (64.6 ± 29.5 vs 78.2 ± 23.7), mHHS (74.2 ± 21.1 vs 83.6 ± 15.9), iHOT-12 (63.6 ± 27.9 vs 74.9 ± 24.8), and VAS satisfaction (73.4 ± 30.3 vs 82.2 ± 24.9), as well as significantly more pain (26.8 ± 23.4 vs 17.9 ± 21.8) (P ≤ .001 for all). Predictors of requiring a postoperative opioid refill included patients with active preoperative opioid use (odds ratio, 3.12 [95% confidence interval, 1.06-9.21]; P = .039) and larger preoperative alpha angles (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .03). Conclusion: Patients requiring ≥1 opioid prescription refill after hip arthroscopy for FAIS had lower preoperative and 2-year PRO scores when compared with patients not requiring refills. Additionally, active opioid use at the time of surgery was found to be predictive of requiring additional opioids for pain management.
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Affiliation(s)
- Edward C Beck
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Justin Drager
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyleen Jan
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonathan Rasio
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vignesh P Krishnamoorthy
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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4
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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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5
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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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6
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Kolaczko JG, Knapik DM, Kroneberger E, Chadha A, Salata MJ. A comprehensive three-phase opiate sparing multimodal pain protocol for hip arthroscopy: a retrospective review. J Hip Preserv Surg 2020; 7:547-553. [PMID: 33948211 PMCID: PMC8081429 DOI: 10.1093/jhps/hnaa057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/04/2020] [Accepted: 11/01/2020] [Indexed: 01/29/2023] Open
Abstract
The aim of this study is to assess the efficacy of a three-phase, multimodal, perioperative pain protocol for primary hip arthroscopy based on pain scores, narcotic use, time to discharge, hospital admission and complications. A retrospective study of patients undergoing primary hip arthroscopy over a 48-month time period was conducted. Patients were separated into a multimodal group consisting of non-narcotic medication, local analgesia and a peripheral nerve block (PNB) versus patients receiving only a PNB. Differences in post-anesthesia care unit (PACU) visual analog scores, PACU time to discharge, PACU opioid consumption, hospital admission and complications between protocols were recorded and analyzed. There were 422 patients who underwent 484 surgeries, with 15 patients crossing over pain protocol groups for surgery on the contralateral hip. One hundred and ninety-six patients underwent 213 procedures in the multimodal group and 241 patients underwent 271 procedures in the PNB group. No differences in baseline characteristics were appreciated between groups. Mean time to discharge was significantly shorter in the multimodal group (137.4 ± 49.3 min versus 176.3 ± 6.5 min; P < 0.001) which also had less post-operative admissions (0 versus 9; P = 0.006) than the PNB group. In patients who crossed over protocol groups, a statistically shorter time to discharge was appreciated with the multimodal protocol compared with the PNB protocol (119.9 ± 32.1 min versus 187.9 ± 9.2; P = 0.012). The three-phase, multimodal pain protocol led to significantly faster discharge times and fewer hospital admissions when compared with isolated PNB in patients undergoing primary hip arthroscopy.
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Affiliation(s)
- Jensen G Kolaczko
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106, USA
| | - Elisabeth Kroneberger
- Case Western University School of Medicine, Health Education Campus, 9501 Euclid Ave, Cleveland, OH 44106, USA
| | - Amrita Chadha
- Department of Anesthesiology, CWRU School of Medicine, Pre-Admission Testing, University Hospitals Ahuja Medical Center, Beachwood, 3999 Richmond Rd, OH 44122, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106, USA.,Department of Orthopaedic Surgery, Sports Medicine Institute, Joint Preservation and Cartilage Restoration Center University Hospitals Cleveland, Cleveland, OH, USA
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7
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Scanaliato JP, Christensen D, Polmear MM, Salfiti C, Gaspar PS, Wolff AB. Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy. Am J Sports Med 2020; 48:2740-2746. [PMID: 32757999 DOI: 10.1177/0363546520943580] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy has become the standard for the operative treatment of symptomatic femoroacetabular impingement. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge. PURPOSE/HYPOTHESIS Our purpose was to perform a single-blinded randomized controlled trial comparing the use of pericapsular injection versus lumbar plexus blockade for postoperative pain control after arthroscopic surgery on the hip. We hypothesized that pericapsular injection would provide equivalent pain relief to that of lumbar plexus blockade while minimizing adverse effects and alleviating the dependence on a qualified individual to administer. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 64 consecutive patients undergoing hip arthroscopy were prospectively assessed over a 6-month period between 2017 and 2018. Patients were randomly allocated to 1 of 2 groups: 32 patients received a lumbar plexus blockade by a single anesthesiologist, while 32 patients received a pericapsular injection of 30 mL of ropivacaine and 12 mg of morphine. Postoperative pain in the postanesthesia care unit (PACU) as measured using the numeric rating scale, time to discharge, PACU morphine equivalents, and adverse effects were collected by PACU staff. Postoperative day 1 and 2 narcotic use was obtained through a telephone call with the patient on postoperative day 3. RESULTS We found no statistically significant difference in PACU pain scores at all time points, although there was a trend toward lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not vary across the 2 arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention. CONCLUSION Pericapsular injection provides equivalent analgesia when compared with lumbar plexus blockade. It is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy. REGISTRATION ClinicalTrials.gov ID: NCT03244631.
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Affiliation(s)
| | | | | | | | | | - Andrew B Wolff
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
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8
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Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here's Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful. Arthroscopy 2020; 36:1584-1586. [PMID: 32503772 DOI: 10.1016/j.arthro.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.
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9
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Glomset JL, Kim E, Tokish JM, Renfro SD, Seckel TB, Adams KJ, Folk J. Reduction of Postoperative Hip Arthroscopy Pain With an Ultrasound-Guided Fascia Iliaca Block: A Prospective Randomized Controlled Trial. Am J Sports Med 2020; 48:682-688. [PMID: 31999469 DOI: 10.1177/0363546519898205] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrasound-guided fascia iliaca blocks have been used for pain control after hip arthroscopy. There is little evidence regarding their effectiveness in comparison with other pain control modalities in patients who have undergone hip arthroscopy. PURPOSE To compare the efficacy of ultrasound-guided fascia iliac block with intra-articular ropivacaine in controlling pain after hip arthroscopy. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Between 2015 and 2017, patients (N = 95) undergoing hip arthroscopy were randomly assigned to 2 groups. The first group received an ultrasound-guided fascia iliaca block with 50 to 60 mL of 0.35% ropivacaine. The second group received an intra-articular injection of 20 mL of 0.5% ropivacaine at the completion of the surgical case. Primary outcomes were postoperative pain scores in the recovery room; at postanesthesia care unit (PACU) discharge; and at 2 weeks, 6 weeks, and 3 months. Secondary outcomes included intraoperative and PACU narcotic usage (converted to morphine equivalent use) as well as readmission rates, PACU recovery time, and postoperative nausea and vomiting. RESULTS Postoperative pain across all points did not significantly differ between the groups. Intraoperative and PACU narcotics did not differ significantly between the groups. Readmission rates, PACU recovery time, and postoperative nausea and vomiting did not significantly differ between the groups. There were no associated complications in either group. CONCLUSION Ultrasound-guided fascia iliaca block for hip arthroscopy had no clinical advantage when compared with onetime intra-articular ropivacaine injection. REGISTRATION NCT02365961 (ClinicalTrials.gov identifier).
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Affiliation(s)
- John L Glomset
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Eugene Kim
- Prisma Health-Upstate, Greenville, South Carolina, USA
| | | | | | | | - Kyle J Adams
- Hawkins Foundation, Greenville, South Carolina, USA
| | - Jason Folk
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
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10
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Kolaczko JG, Knapik DM, Salata MJ. Peri-operative pain management in hip arthroscopy: a systematic review of the literature. J Hip Preserv Surg 2019; 6:353-363. [PMID: 32537236 PMCID: PMC7279516 DOI: 10.1093/jhps/hnz050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/11/2019] [Accepted: 10/03/2019] [Indexed: 01/05/2023] Open
Abstract
The purpose of this article was to review current literature on peri-operative pain management in hip arthroscopy. A systematic review of the literature on pain control in hip arthroscopy published January 2008 to December 2018 was performed. Inclusion criteria consisted of English language or articles with English translations, subjects undergoing hip arthroscopy with documented peri-operative pain control protocols in studies reporting Level I to IV evidence. Exclusion criteria were non-English articles, animal studies, prior systematic review or meta-analyses, studies not reporting peri-operative pain control protocols, studies documenting only pediatric (<18 years of age) patients, studies with Level V evidence and studies including less than five subjects. Statistical analysis was performed to assess pain protocols on narcotic consumption in PACU, VAS score on discharge, time to discharge from PACU and incidence of complications. Seventeen studies were included, comprising 1674 patients. Nerve blocks were administered in 50% of patients (n = 838 of 1674), of which 88% (n = 740 of 838) received a pre-operative block while 12% (n = 98 of 838) post-operative block. Sixty-eight complications were recorded: falls (54%, n = 37), peripheral neuritis (41%, n = 28), seizure (1.5%, n = 1), oxygen desaturation and nausea (1.5%, n = 1) and epidural spread resulting in urinary retention (1.5%, n = 1). No significant differences in narcotic consumption, VAS score at discharge, time until discharge or incidence of complication was found based on pain control modality utilized. No statistically significant difference in PACU narcotic utilization, VAS pain scores at discharge, time to discharge or incidence of complications was found between peri-operative pain regimens in hip arthroscopy.
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Affiliation(s)
- Jensen G Kolaczko
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Hanna House 5043, Cleveland, OH 44106, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Hanna House 5043, Cleveland, OH 44106, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Hanna House 5043, Cleveland, OH 44106, USA.,Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, University Hospitals Cleveland Medical Center, The Cleveland Browns Football Organization, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106, USA
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11
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LaPorte C, Rahl MD, Ayeni OR, Menge TJ. Postoperative Pain Management Strategies in Hip Arthroscopy. Curr Rev Musculoskelet Med 2019; 12:479-485. [PMID: 31650392 DOI: 10.1007/s12178-019-09579-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Hip arthroscopy is a rapidly growing field due to its significant diagnostic and therapeutic value in the management of numerous hip disorders. Adequate control of postoperative pain in patients undergoing hip arthroscopy continues to be a challenging and evolving area in orthopedics. In the absence of standardized protocols for pain management in these patients, a variety of different approaches have been utilized in an effort to find a regimen that is effective at reducing postoperative pain, narcotic consumption, and cost to the patient and healthcare system. The purpose of this article, therefore, is to provide a comprehensive review of current literature regarding postoperative pain management techniques in patients undergoing hip arthroscopy. RECENT FINDINGS Recent literature demonstrates the importance of a multimodal approach to treat postoperative pain in patients undergoing hip arthroscopy. When a peripheral nerve block or intraoperative anesthetic is used in combination with a pre- and postoperative analgesic medication regimen, patients report less pain and postoperative narcotic consumption. Patient-reported pain scores and postoperative opioid use were similar between the different modalities, however, postoperative complications appear to be less in groups receiving intra-articular (IA) injection or local anesthetic infiltration (LAI) compared to peripheral nerve blocks. In summary, we present evidence that intraoperative techniques, such as IA injection or LAI, in conjunction with pre- and postoperative pain medications, offers an effective multimodal strategy for treating postoperative pain following hip arthroscopy. This topic is of increasing importance due to the need for cost-effective strategies of managing pain and decreasing opioid consumption following hip arthroscopy.
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Affiliation(s)
- Collin LaPorte
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Michael D Rahl
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Travis J Menge
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA. .,Spectrum Health Medical Group Orthopedics & Sports Medicine & Hip Arthroscopy, 4100 Lake Dr SE, Suite 300, Grand Rapids, MI, 49546, USA.
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12
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Efficacy of preemptive analgesia versus postoperative analgesia of celecoxib on postoperative pain, patients' global assessment and hip function recovery in femoroacetabular impingement patients underwent hip arthroscopy surgery. Inflammopharmacology 2019; 28:131-137. [PMID: 31595391 PMCID: PMC6989418 DOI: 10.1007/s10787-019-00648-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 11/03/2022]
Abstract
We aimed to investigate the efficacy of preemptive analgesia of celecoxib on postoperative pain, patients' global assessment (PGA) and hip function recovery compared to postoperative analgesia of celecoxib in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy surgery (HAS). The 100 FAI patients underwent HAS were randomly allocated to preemptive analgesia group (N = 50) or postoperative analgesia group (N = 50) as a 1:1 ratio for 3 months. Pain visual analog scale (VAS) score, PGA score, rescue-use pethidine consumption and Harris hip score were assessed. Compared to postoperative analgesia group, pain VAS score decreased on day 1 (P = 0.036), day 2 (P = 0.046) and day 3 (P = 0.046), while was similar prior to operation (P = 0.587), on day 7 (P = 0.398), at month 1 (P = 0.461) and month 3 (P = 0.805) in preemptive analgesia group. Besides, rescue-use pethidine consumption was decreased in preemptive analgesia group than postoperative analgesia group within 3 days (P = 0.016) and within 7 days (P = 0.033) post-operation. For PGA score, it reduced on day 2 (P = 0.030) and day 3 (P = 0.048), while was similar prior to operation (P = 0.699), on day 1 (P = 0.699), day 7 (P = 0.224), at month 1 (P = 0.640) and month 3 (P = 0.400) in preemptive analgesia group than postoperative analgesia group. For Harris hip score, it was similar prior to operation (P = 0.372), on day 7 (P = 0.366), at month 1 (P = 0.466) and month 3 (P = 0.658) between the two groups. In conclusion, preemptive analgesia of celecoxib decreases short-term postoperative pain and PGA, but without effect on long-term hip function recovery than postoperative analgesia of celecoxib in FAI patients who underwent HAS.
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13
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Shin JJ, McCrum CL, Mauro CS, Vyas D. Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies. Am J Sports Med 2018; 46:3288-3298. [PMID: 29028436 DOI: 10.1177/0363546517734518] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications. PURPOSE To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy. STUDY DESIGN Systematic review. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature for postoperative pain control after hip arthroscopy was performed using electronic databases. Only comparative clinical studies with level 1 to 3 evidence comparing a method of postoperative pain control with other modalities or placebo were included in this review. Case series and studies without a comparative cohort were excluded. RESULTS Several methods of pain management have been described for hip arthroscopy. A total of 14 studies met our inclusion criteria: 3 on femoral nerve block, 3 on lumbar plexus block, 3 on fascia iliaca block, 4 on intra-articular injections, 2 on soft tissue surrounding surgical site injection, and 2 on celecoxib (4 studies compared 2 or more methods of analgesia). The heterogeneity of the studies did not allow for pooling of data. Single-injection femoral nerve blocks and lumbar plexus blocks provided improved analgesia, but increased fall rates were observed. Fascia iliaca blocks do not provide adequate pain relief when compared with surgical site infiltration with local anesthetic and are associated with increased risk of cutaneous nerve deficits. Patients receiving lumbar plexus block experienced significantly decreased pain compared with fascia iliaca block. Portal site and periacetabular injections provide superior analgesia compared with intra-articular injections alone. Preoperative oral celecoxib, compared with placebo, resulted in earlier time to discharge and provided significant pain relief up to 24 hours. CONCLUSION Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. Intra-articular and portal site injections with local anesthetics and preoperative celecoxib can decrease opioid consumption. There is a lack of high-quality evidence on this topic, and further research is needed to determine the best approach to manage postoperative pain and optimize patient satisfaction.
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Affiliation(s)
- Jason J Shin
- Department of Orthopaedics and Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chris L McCrum
- Department of Orthopaedics and Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Texas Southwestern, Department of Orthopaedic Surgery, Dallas, Texas, USA
| | - Craig S Mauro
- Department of Orthopaedics and Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dharmesh Vyas
- Department of Orthopaedics and Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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14
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Anciano Granadillo V, Cancienne JM, Gwathmey FW, Werner BC. Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications. Arthroscopy 2018; 34:2359-2367. [PMID: 29730217 DOI: 10.1016/j.arthro.2018.03.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this article is to (1) examine trends in preoperative and prolonged postoperative opioid analgesic use in patient undergoing hip arthroscopy, (2) characterize risk factors for prolonged opioid analgesic use following hip arthroscopy, and (3) explore preoperative and prolonged postoperative opioid analgesic use as independent risk factors for complications following hip arthroscopy. METHODS A private insurance database was queried for patients undergoing hip arthroscopy from 2007 to 2015 with a minimum of 6 months of follow-up. Independent risk factors for prolonged opioid analgesic use were determined. Preoperative and prolonged opioid analgesic use as risk factors for complications were examined. RESULTS There was a significantly decreasing trend in preoperative (P = .002) and prolonged postoperative (P = .009) opioid analgesic use. The most significant risk factor for prolonged postoperative opioid analgesic use was preoperative use (odds ratio [OR], 3.61; P < .0001). Other preoperative prescriptions, including muscle relaxants (OR, 1.5; P < .0001) and anxiolytics (OR, 2.0; P < .0001), were also significant risk factors. Preoperative opioid analgesic use was a significant risk factor for postoperative complications, including emergency room visits (OR, 2.1; P < .0001) and conversion to total hip arthroplasty (THA) (OR, 1.6; P < .0001). Prolonged postoperative opioid analgesic use was associated with a higher risk of revision hip arthroscopy (OR, 1.4; P = .0004) and conversion to THA (OR, 1.8; P < .0001). CONCLUSIONS More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged opioid analgesic use is preoperative opioid analgesic use. Additionally, anxiolytics, substance use or abuse, morbid obesity, and back pain were among the more notable risk factors for prolonged postoperative opioid analgesic use. Preoperative and prolonged postoperative opioid analgesic use was associated with a higher likelihood of several adverse effects/complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Victor Anciano Granadillo
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A..
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15
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Cunningham D, Lewis B, Hutyra C, Nho S, Olson S, Mather R. Prospective, Observational Study of Opioid Use After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2018; 34:1488-1497.e6. [PMID: 29398210 PMCID: PMC5936669 DOI: 10.1016/j.arthro.2017.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide estimates of postoperative opioid use after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify risk factors for increased postoperative opioid use. METHODS All patients aged at least 18 years who were undergoing hip arthroscopy for FAI syndrome performed by 1 of 2 hip-preservation surgeons between November 2015 and August 2016 were eligible for inclusion in this study. Target minimum enrollment was set at 30 patients per surgeon based on an a priori sample size calculation. Enrolled patients completed the International Hip Outcome Tool, visual analog pain scale, Pain Catastrophizing Scale, abbreviated Patient Health Questionnaire, and questions regarding demographic characteristics and opioid and anti-inflammatory use. Opioid consumption was assessed through pill counting at 2- and 6-week postoperative appointments. Of 80 patients enrolled, 67 had complete 2- and 6-week opioid use data. Patient and operative factors were correlated with outcomes in multivariate models. RESULTS Opioid use in the 2 weeks before surgery was significantly associated with higher postoperative opioid use at 2 weeks postoperatively (253.8 additional oral morphine equivalents [OMEs]; 95% confidence interval [CI], 171.2-336.5 additional OMEs; P < .0001; n = 73) and 6 weeks postoperatively (385.3 additional OMEs; 95% CI, 241.6-529.0 additional OMEs; P < .0001; n = 67). By 6 weeks postoperatively, 41 of 52 patients (79%) without opioid use in the 2 weeks before surgery used 30 or fewer 5-mg oxycodone pills compared with only 2 of 15 patients (13%) with preoperative use (odds ratio, 24.9; 95% CI, 4.2-148.5; P < .0001). CONCLUSIONS Among patients undergoing hip arthroscopy for FAI syndrome, any opioid use in the 2 weeks preceding surgery was the strongest predictor of opioid use after hip arthroscopy. The impact of preoperative opioid use far exceeded the impact of other baseline patient and operative factors. Assessment of preoperative opioid use could be an important factor in guiding postoperative opioid prescribing. LEVEL OF EVIDENCE Level II, prospective observational study.
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Affiliation(s)
- Daniel Cunningham
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Brian Lewis
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Carolyn Hutyra
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Shane Nho
- Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Chicago, IL 60612
| | - Steven Olson
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Richard Mather
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
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16
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Abrams GD, Chang W, Dragoo JL. In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications. Am J Sports Med 2017; 45:3345-3350. [PMID: 28903012 DOI: 10.1177/0363546517724423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A variety of medications are administered to the intra-articular space for the relief of joint pain. While amide-type local anesthetics have been extensively studied, there is minimal information regarding the potential chondrotoxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid medications. PURPOSE To investigate the in vitro chondrotoxicity of single-dose equivalent concentrations of ketorolac, morphine, meperidine, and fentanyl on human chondrocytes. STUDY DESIGN Controlled laboratory study. METHODS Human cartilage was arthroscopically harvested from the intercondylar notch and expanded in vitro. Gene expression of cultured chondrocytes before treatment was performed with quantitative polymerase chain reaction for type I collagen, type II collagen, aggrecan, and SOX9. Chondrocytes were then exposed to 0.01%, 0.02%, and 0.04% morphine sulfate; 0.3% and 0.6% ketorolac tromethamine; 0.5%, 1.0%, and 1.5% meperidine hydrochloride; 0.0005% and 0.001% fentanyl citrate; and saline. A custom bioreactor was used to constantly deliver medications, with the dosage of each medication and the duration of exposure based on standard dose equivalents, medication half-lives, and differences in the surface area between the 6-well plates and the native joint surface. After treatment, a live/dead assay was used to assess chondrocyte viability and if minimal cell death was detected. A subset of samples after treatment was maintained to analyze for possible delayed cell death. RESULTS All tested concentrations of ketorolac and meperidine caused significantly increased cell death versus the saline control, demonstrating a dose-response relationship. The morphine and fentanyl groups did not show increased chondrotoxicity compared with the saline group, even after 2 weeks of additional culture. CONCLUSION In vitro exposure of chondrocytes to single-dose equivalent concentrations of either ketorolac or meperidine demonstrated significant chondrotoxicity, while exposure to morphine or fentanyl did not lead to increased cell death.
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Affiliation(s)
- Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Wenteh Chang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jason L Dragoo
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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17
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Kleine SA, Budsberg SC. Synovial membrane receptors as therapeutic targets: A review of receptor localization, structure, and function. J Orthop Res 2017; 35:1589-1605. [PMID: 28374922 DOI: 10.1002/jor.23568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/28/2017] [Indexed: 02/04/2023]
Abstract
Joint pathology and degeneration is a significant cause of pain. The synovial membrane plays an important role in maintenance of the joint, contributes to the pathology of many arthropathies and may be adversely affected in joint disease. Improving knowledge of the receptors present within the synovium will aid in a better understanding of joint pathology and the development of new treatments for diseases such as osteoarthritis and rheumatoid arthritis. Knowledge of the location and function of synovial membrane receptors (both in healthy and diseased synovium) may provide important targets in the treatment of various arthropathies. Classic pain receptors such as opioid receptors in the synovium are a mainstay in local and systemic management of chronic pain in many species. In addition to these, many other receptors such as bradykinin, neurokinin, transient receptor potential vanilloid, and inflammatory receptors, such as prostanoid and interleukin receptors have been discovered within the synovial membrane. These receptors are important in pain, inflammation, and in maintenance of normal joint function and may serve as targets for pharmacologic intervention in pathologic states. The goal of this review is to outline synovial membrane receptor localization and local therapeutic modulation of these receptors, in order to stimulate further research into pharmacological management of arthropathies at the local level. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1589-1605, 2017.
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Affiliation(s)
- Stephanie A Kleine
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens 30602, Georgia
| | - Steven C Budsberg
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens 30602, Georgia
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18
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Cook CE, Rhon DI, Lewis BD, George SZ. Post-operative opioid pain management patterns for patients who receive hip surgery. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:14. [PMID: 28298221 PMCID: PMC5353894 DOI: 10.1186/s13011-017-0094-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/14/2017] [Indexed: 01/07/2023]
Abstract
Background Identifying optimal, post-operative opioid management strategies is a priority of health providers and government agencies. At present, there are no studies we are aware of that have formally investigated opioid prescribing patterns for post-operative non-arthroplasty orthopedic conditions such as femoroacetabular impingement, nor has any study investigated the influence of opioid prescription patterns on health care costs and utilization. We aimed to investigate a subgrouping scheme associated with post-operative opioid prescription strategies and measure the subgroups’ direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery. Methods The study was an observational cohort of routine military clinical practices. We used cluster analysis to characterize pre-operative (12 months) and post-operative (24 months) opioid prescription patterns. Linear mixed effects modeling (with statistical controls for baseline status) identified opioid prescription pattern subgroups and identified subgroup differences in health care utilization and costs. Results Two distinct clusters were identified representing 1) short-duration, high total days’ supply (SD-HD), and 2) long-duration, lesser total days’ supply (LD-LD) post-operative prescription patterns. Significantly higher costs and health care utilization for both hip-related and non-hip-related variables were consistently identified in the SD-HD group. Conclusions Long-term opioid prescription use has been identified as a concern, but our findings demonstrate that LD-LD post-operative opioid management for hip surgery recipients was associated with lower costs and utilization. Whether these management patterns were a reflection of pre-operative health status, impacted pain-related outcomes, or can be replicated in other orthopedic procedures remains a consideration for future studies. Trial registration NA.
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Affiliation(s)
- Chad E Cook
- Division of Physical Therapy, Duke University, 2200 West Main Street, Durham, NC, 27705, USA.
| | - Daniel I Rhon
- Clinical Outcomes Research, Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, 78234, USA.,Baylor University, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Brian D Lewis
- Department of Orthopaedics, Duke University, Box 3389, Durham, NC, 27710, USA
| | - Steven Z George
- Department of Orthopaedics, Musculoskeletal Research, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA
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