Paper 44: Femoral Nerve Blocks are Effective for Post-Operative Pain Control after Hip Arthroscopy

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.

Download Full-text

Pain management practice patterns after hip arthroscopy: an international survey

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa050 ◽

2020 ◽

Author(s):

Flávio L Garcia ◽

Brady T Williams ◽

Bhargavi Maheshwer ◽

Asheesh Bedi ◽

Ivan H Wong ◽

...

Keyword(s):

Pain Management ◽

Hip Arthroscopy ◽

Pain Control ◽

Sports Medicine ◽

Management Practice ◽

Professional Organizations ◽

International Survey ◽

Nerve Blocks ◽

Optimal Approach ◽

Answer Choice

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.

Download Full-text

COMPARISON OF CONTINUOUS ADDUCTOR CANAL AND FEMORAL NERVE BLOCKS FOR ANALGESIA AND SPORTS READINESS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ADOLESCENT PATIENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00221 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0022

Author(s):

Erica L. Holland ◽

Robin Robbins ◽

Daniel K-W. Low ◽

Adrian Bosenberg ◽

Viviana Bompadre ◽

...

Keyword(s):

Cruciate Ligament ◽

Femoral Nerve ◽

Return To Sports ◽

Nerve Blocks ◽

Pain Scores ◽

Post Operative Pain ◽

Adolescent Patients ◽

Surgical Data ◽

Anterior Cruciate ◽

Quadriceps Function

Background: Continuous femoral nerve blocks (cFNB) have become a popular method for post-operative analgesia for patients undergoing anterior cruciate ligament reconstruction (ACLR). However, early weight-bearing and the return of quadriceps function favor a motor sparing block, such as a continuous adductor canal nerve block (cACB). Hypothesis/Purpose: We retrospectively compared cACB to cFNB in adolescent patients undergoing ACLR, assessing early post-operative pain scores, narcotic usage, and patient satisfaction; and return of quadriceps function and sports readiness at six months post-surgery. We hypothesized that cACB compared to cFNB would result in in a greater likelihood of sports readiness at six months without having compromised analgesia in the early post-operative period. Methods: We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR between January 2016 and September 2018 and received either a cACB or cFNB for post-operative pain management. Patient demographic and surgical data, post-operative pain scores, opioid consumption, satisfaction and complications, dates and results of the Return to Sports (RTS) evaluations were collected from the medical record. Comparisons of categorical and continuous variables between groups were made using the χ 2 test, Spearman correlation test, and one-way ANOVA with Bonferroni adjustment. Results: Ninety-one patients (53 with cFNB, 38 with cACB) were reviewed for post-operative analgesia outcomes and quadriceps function at six months and beyond. Analysis of demographic and surgical data revealed no difference in the make-up of the two groups. There were no significant differences between groups in the total oxycodone use PODs 1-3 ( p = 0.213), daily post-operative pain scores ( p > 0.25), or satisfaction with the blocks ( p = 0.93). There was no difference in time to RTS nor in the percentage of patients who achieved a 90% limb symmetry index for quadriceps strength when comparing the two groups at the six-month mark and beyond ( p = 0.384). Conclusions: We found no difference in post-operative analgesic requirements and high satisfaction in both groups when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Readiness for return to sports and return of quadriceps function at six months and beyond does not appear to vary with regional technique, either cACB or cFNB, employed at surgery.

Download Full-text

Are Femoral Nerve Blocks Effective for Early Postoperative Pain Management After Hip Arthroscopy?

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2012.01.003 ◽

2012 ◽

Vol 28 (8) ◽

pp. 1064-1069 ◽

Cited By ~ 45

Author(s):

James P. Ward ◽

David B. Albert ◽

Robert Altman ◽

Rachel Y. Goldstein ◽

Germaine Cuff ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Hip Arthroscopy ◽

Femoral Nerve ◽

Postoperative Pain Management ◽

Nerve Blocks

Download Full-text

A Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.42117 ◽

2019 ◽

Vol 3 (3) ◽

pp. 248-251 ◽

Cited By ~ 2

Author(s):

Daniel Mantuani ◽

Josh Luftig ◽

Andrew Herring ◽

Andrea Dreyfuss ◽

Arun Nagdev

Keyword(s):

Pain Management ◽

Acute Appendicitis ◽

Pain Control ◽

Single Injection ◽

Femoral Nerve ◽

Injured Patient ◽

Erector Spinae ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Hospital System

Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.1 The single injection, ultrasound-guided erector spinae plane (ESP) block is a technique safely used for pain control for rib fractures that can be easily performed at the bedside and integrated into optimal emergency care. A more inferiorly located ultrasound-guided ESP block has been recently described in the anesthesia literature for perioperative pain control for various abdominal surgeries but has not yet been described for patients with acute appendicitis. Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.

Download Full-text

Peri-operative pain management in hip arthroscopy: a systematic review of the literature

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz050 ◽

2019 ◽

Vol 6 (4) ◽

pp. 353-363

Author(s):

Jensen G Kolaczko ◽

Derrick M Knapik ◽

Michael J Salata

Keyword(s):

Systematic Review ◽

Pain Management ◽

Hip Arthroscopy ◽

Pain Control ◽

Review Of The Literature ◽

Discharge Time ◽

Nerve Blocks ◽

Vas Score ◽

Significant Difference ◽

Control Protocols

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.

Download Full-text

Do femoral nerve blocks improve acute pain control in adults with isolated hip fractures?

CJEM ◽

10.1017/s1481803500009465 ◽

2004 ◽

Vol 6 (06) ◽

pp. 441-443

Author(s):

Katrina Hurley

Keyword(s):

Hip Fractures ◽

Acute Pain ◽

Pain Control ◽

Femoral Nerve ◽

Nerve Blocks

Download Full-text

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00149 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0014

Author(s):

John Larson Glomset ◽

Eugene J. Kim ◽

John M. Tokish ◽

Suzanne D. Renfro ◽

Tyler B. Seckel ◽

...

Keyword(s):

Postoperative Pain ◽

Hip Arthroscopy ◽

Pain Control ◽

Recovery Time ◽

Postoperative Nausea And Vomiting ◽

Ultrasound Guided ◽

Readmission Rates ◽

Post Operative Pain ◽

Clinical Advantage ◽

Fascia Iliaca Block

Objectives: Ultrasound guided fascia-Iliaca blocks have been used for pain control following hip arthroscopy. There is little evidence regarding their effectiveness in comparison to other pain control modalities in hip arthroscopy patients. To compare efficacy of ultrasound guided fascia iliac block with intra-articular ropivacaine in controlling pain after hip arthroscopy. Methods: Between 2015 and 2017, 95 patients undergoing hip arthroscopy were randomly assigned to 2 groups. The first group received an ultrasound-guided fascia-iliaca block with 50-60mLs of 0.35% ropivacaine. The second group received intra-articular injection of 20 mL of 0.5% ropivacaine at the completion of the surgical case. Primary outcomes were post-operative pain scores in the recovery room, at PACU discharge, 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 (PONV). Results: Postoperative pain across all points did not significantly differ between the 2 groups. Intraoperative and PACU narcotics did not differ significantly between the 2 groups. Readmission rates, PACU recovery time and PONV did not significantly differ between the 2 groups. There were no associated complications in either group. Conclusion: Ultrasound guided fascia iliaca block for hip arthroscopy had no clinical advantage when compared to one time intra-articular ropivacaine injection. Furthermore, an intraarticular injection decreases costs and is a safe and more efficient modality for postoperative pain control following hip arthroscopy.

Download Full-text