Abstract
Purpose: Hip arthroscopy is a surgery with favorable outcomes to treat labral tears of the hip. This retrospective review was conducted to identify an optimal anesthetic technique for hip arthroscopy to minimize postoperative pain and decrease opioid consumption. Methods: A retrospective analysis was performed for 92 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) with labral tear under general anesthesia (G) with fascia-iliaca block (64 patients) or regional anesthesia (R) with fascia-iliaca block (28 patients) from March 9, 2016 to April 9, 2018. Data collected included: demographics, diagnosis, ASA status, time in surgery, medications administered, type of anesthesia administered, pain scores, use of straight catheter, and time in PACU. Results: Patients who underwent hip arthroscopy under regional anesthesia reported significantly less first (G: 3.4 (3.9), R: 1.3 (3.0), p = 0.0085) and average (G: 3.8 (2.5), R: 2.0 (2.2), p = 0.0038) pain post-operatively. Patients under regional anesthesia also received less total morphine milligram equivalents (MME) intraoperatively and post-operatively (G: 40.8 (21.7) MME, R: 24.9 (17.8), p = 0.004 MME). Patients under regional anesthesia had a significantly higher incidence of urinary retention (G: 3.1%, R: 28.6%, p = 0.009) and increased time spent in PACU (G = 181.9 (86.3), R: 251.4 (80.4), p = 0.0001). Conclusions: The administration of regional anesthesia resulted in significantly lower pain scores and perioperative opioid consumption compared to general anesthesia in patients undergoing hip. This may be the optimal anesthetic technique for pain control; however, incidence of urinary retention and time to discharge are significantly increased. Prospective randomized control trials are needed to compare general anesthesia and regional anesthesia for hip arthroscopy.
Highlights
Hip arthroscopy is a growing field of orthopedics with dramatic increases in its incidence and indications [1] [2] [3]
A retrospective analysis was performed for 92 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) with labral tear under general anesthesia (G) with fascia-iliaca block (64 patients) or regional anesthesia (R) with fascia-iliaca block (28 patients) from March 9, 2016 to April 9, 2018
Patients under regional anesthesia had a significantly higher incidence of urinary retention (G: 3.1%, R: 28.6%, p = 0.009) and increased time spent in Post Anesthesia Care Unit (PACU) (G = 181.9 (86.3), R: 251.4 (80.4), p = 0.0001)
Summary
Hip arthroscopy is a growing field of orthopedics with dramatic increases in its incidence and indications [1] [2] [3]. The surgery requires decompression of the offending bony anatomy with a burr (femoroplasty and acetabuloplasty) as well as repairing the injured labrum, which is the result of the two pathologic structures impinging on one another This surgery is notable for significant improvement in patient reported outcomes, with high patient satisfaction [5] [6]. Contributing factors include complexity of hip innervation, individualized response to pain, as well as the surgical technique itself, which requires a large amount of distraction of the joint. Since these often are performed in an ambulatory setting, optimal control of pain and nausea is of utmost importance for safe and speedy discharge from the Post Anesthesia Care Unit (PACU). Over the last decade there have been several methods proposed to optimize pain control and decrease opioid consumption perioperatively
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