No clinical advantage in fascia iliaca block vs intra-articular injection in hip arthroscopy
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Ultrasound-guided fascia iliaca block for hip arthroscopy is as effective at controlling postoperative pain and opioid consumption as an intra-articular injection, according to results of a published study.
“The optimal way to manage perioperative pain and intraoperative anesthesia in hip arthroscopy patients is yet to be determined,” Jason Folk, MD, of Steadman Hawkins Clinic of the Carolinas at Prisma Health-Upstate in Greenville, South Carolina, told Healio Orthopedics. “There still exists the unpredictable and variable patient pain response to the insult of arthroscopic hip surgery.”
All patients who underwent hip arthroscopy by a single fellowship-trained hip arthroscopist between 2015 and 2017 were invited to participate in the study. A total of 84 patients (aged 18 to 65 years old) were scheduled to undergo surgery by the senior surgeon and had an American Society of Anesthesiologists score of 1 to 3.
On the day of surgery, patients received multimodal analgesia with an oral preoperative cocktail that included acetaminophen (15 mg/kg to 1000mg), celecoxib (Celebrex, Pfizer; 400 mg), pregabalin (Lyrica, Pfizer; 75 mg) and oxycodone (OxyContin, Purdue Pharma; 10 mg). Patients in the fascia iliaca block group (n=41) received up to 60 mL of 0.35% ropivacaine at a dose of 3 mg/kg, and patients in the intra-articular group (n=43) received 20 mL of 0.5% ropivacaine.
Postoperatively, hydromorphone was given in 0.2 mg- to 0.5-mg increments as a first-line treatment opioid for pain. Nausea was treated with promethazine at 6.25 mg as first-line treatment, and second-line treatment was repeated promethazine 15 minutes after the first dose along with diphenhydramine at 6.25 mg.
Follow-up was at 2 and 6 weeks and 3 months postoperatively, and pain scores were evaluated and recorded. Pain scores were similar between both groups at all points and there were no significant differences in morphine-equivalent use, recovery time or readmissions, according to the study.
“While our study found no significant complications associated with the [fascia iliaca block], they can be a technical challenge with difficulty of administration based on patient anatomy and they are not always predictably reproduced,” Folk said. “Looking at short-acting spinals and perioperative oral and intravenous medication cocktails used in conjunction and in combination with traditional general sedation, local anesthetic modalities will continue to add to the challenge of postoperative pain management in hip arthroscopy patients.” – by Erin T. Welsh
Disclosures: Folk reports receiving payments from Smith & Nephew and financial or material support from Arthrex, ArthroCare, Arthrosurface, Breg, DJ Orthopedics, Neurotech and Pacira. Please see the study for all other authors’ relevant financial disclosures.
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