In Response.

Abstract

We appreciate the response from Drs Ben-David and La Colla and their interest in our study looking at the incidence of intra-abdominal fluid extravasation (IAFE) after hip arthroscopy.1 Drs Ben-David and La Colla suggest that the true incidence of IAFE may be even greater than 16% and refer to a study by Branney et al2 who found that the mean detectable volume via ultrasound was 619 mL in the right upper quadrant via assessment of Morison’s pouch. We agree that the true incidence of IAFE may indeed be greater than 16%. In our study, the average time to perform the focused assessment with sonography for trauma examination was often less than 3 minutes.1 Perhaps a more thorough examination would have yielded a higher incidence. Additionally, further studies are needed to identify whether the degree of IAFE as detectable by ultrasound correlates to the severity of pain in the postoperative period. It interested us greatly to read that the quadratus lumborum block (QLB) is routinely used as a regional anesthesia technique at their institution for postoperative pain after hip arthroscopy. At our institution, a study on the analgesic efficacy of the lumbar plexus block demonstrated reduced resting pain scores after hip arthroscopy. However, there were no differences in postanesthesia care unit analgesic usage, postanesthesia care unit pain with movement, or patient satisfaction.3 Therefore, our current approach is the use of multimodal analgesia with a rare postoperative analgesic block for circumstances such as patients with a history of chronic pain. The insight into the QLB serving as both an analgesic block to the hip4 as well as to the peritoneum, as seen by its benefit in laparoscopic gynecologic surgery,5 may be the key to its optimal pain control for hip arthroscopy. Ultimately, additional studies should be performed to determine if QLB is indeed superior to alternatives, such as lumbar plexus block.3 As point of care ultrasound continues to expand in use and the number of practitioners increases, we believe novel applications, such as its use after hip arthroscopy, will continue to provide insight into ways to improve patient satisfaction and perioperative outcomes. Stephen C. Haskins, MDJemiel A. Nejim, MDDepartment of AnesthesiologyHospital for Special SurgeryNew York, New York[email protected]