Implementation of the Obturator Nerve Block into a Supra-Inguinal Fascia Iliaca Compartment Block Based Analgesia Protocol for Hip Arthroscopy: Retrospective Pre-Post Study.

Seounghun Lee,Woosuk Chung,Sangmin Lee,Wonhyung Lee,Young-Kwon Ko,Deuk-Soo Hwang,Hongsik Eom,Jung-Mo Hwang,Chahyun Oh,Boohwi Hong

doi:10.3390/medicina56040150

Abstract

Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0–890.0) µg; FO: 482.8 (305.8–635.0) µg; p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8–803.0) µg). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.

Highlights

Cases of hip arthroscopy have been increasing in various diseases of the hip joint, such as femoro-acetabular impingement, osteochondritis, labral tear, removal of loose bodies, septic arthritis, or unknown hip pain [1]
It was recognized that the pain score or opioid consumption were independent of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy patients
A total of 87 patients were enrolled in the study, and 21 patients received SI-FICB while 19 patients received SI-FICB with obturator nerve block

Summary

Introduction

Cases of hip arthroscopy have been increasing in various diseases of the hip joint, such as femoro-acetabular impingement, osteochondritis, labral tear, removal of loose bodies, septic arthritis, or unknown hip pain [1]. Lumbar plexus block produces anesthesia of the anterior part of the hip capsule where the greatest concentration of sensory nerve endings and mechanoreceptors are found [9] It has been suggested as an effective analgesic technique after hip arthroscopy [7,10]. One of the anterior approach to the lumbar plexus block is supra-inguinal fascia iliaca compartment block (SI-FICB) [11,12]. The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent It is controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy.

Methods

Results

Conclusion