Fascia iliaca block did not reduce morphine equivalent dose after hip arthroscopy
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Published results showed no differences in postoperative morphine equivalent dose among patients who did and those who did not receive fascia iliaca block for elective hip arthroscopic labral repair and treatment of femoroacetabular impingement.
Researchers randomly assigned 60 patients with symptomatic femoroacetabular impingement, hip labral tear or cartilage damage undergoing elective arthroscopic hip surgery to receive either preoperative fascia iliaca block (n=27) or no fascia iliaca block (n=33). Researchers measured postoperative morphine equivalent dose, self-reported pain level and patient satisfaction.
Although the fascia iliaca block and control groups had no significant differences in sex, age, height, weight or BMI, results showed a significant difference in distribution of American Society of Anesthesiologists classification. Researchers found no significant differences in postoperative morphine equivalent dose between the two groups. The fascia iliaca block and control groups also had no significant differences in self-reported VAS pain and patient satisfaction at any of the measured postoperative times, according to results.
“The most important finding of the present study was that there were no significant differences in postoperative [morphine equivalent dose] MED between the control group and the [fascia iliaca block] FIB group following hip arthroscopy,” the authors wrote. “The efficacy of the preoperative FIB was measured by postoperative MED, as well as patient-reported pain and satisfaction levels. There were no significant differences between the FIB group and control group for any of these measures at any time point, including on the day of surgery, which contradicts prior investigations.”
Perspective
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Jason W. Folk, MD
The optimal way to manage perioperative pain and intraoperative anesthesia in hip arthroscopy patients is yet to be determined. There still exists the unpredictable and variable patient response to the insult of arthroscopic hip surgery. The fascia iliaca block has been investigated as an adjunct to the perioperative management of this, at times, challenging patient population. Determining its clinical efficacy is especially important in light of the added time, expense and expertise requirements of the fascia iliaca block and also the variable patient experience associated with its administration. The fascia iliaca block can be a technical challenge based on patient anatomy and can be difficult to predictably reproduce. This study is consistent with and adds to the growing body of evidence suggesting fascia iliaca blocks do not add clinically significant benefit to the perioperative management of hip arthroscopy patients. Continued investigation of perioperative oral and IV medication cocktails, in conjunction and in combination with traditional general, regional and local anesthetic modalities, will continue to add to the challenge of postoperative pain management in hip arthroscopy patients.
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