Fascia Iliaca Blockade With the Addition of Liposomal Bupivacaine Versus Plain Bupivacaine for Perioperative Pain Management During Hip Arthroscopy: A Double-Blinded Prospective Randomized Control Trial

Purcell, Richard L.; Brooks, Daniel I.; Steelman, Theodore; Christensen, Daniel; Dickens, Jonathan; Kent, Michael L.; McCabe, Michael P.; Anderson, Terrence D.

doi:10.1016/j.arthro.2019.03.056

Cited by 25 publications

(46 citation statements)

References 24 publications

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“…The inclusion criteria were age . 16 or \50 years and a clinical indication for hip arthroscopy. Exclusion criteria were a known allergy to ropivacaine or morphine, a primary language other than English, pregnancy in women, preoperative narcotic use for hip pain, and/or a preexisting chronic pain disorder.…”

Section: Methodsmentioning

confidence: 99%

“…Hip arthroscopy is commonly performed in the outpatient ambulatory surgical center setting; however, the optimal method to control pain while minimizing complications is not clear. 1,4,13,14,16,17,20 Most patients are discharged to return home from the postanesthesia care unit (PACU) on their day of surgery. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge.…”

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confidence: 99%

“…2,10,15 The injection of local anesthetic around major nerves (peripheral nerve blockade) is increasingly used to manage postoperative hip arthroscopy-associated pain, with various pharmacologic cocktails and methods of infiltration having been investigated. 7,16,19,21,[25][26][27] Numerous studies continue to demonstrate improvements in analgesia, postoperative opioid use, and/or quicker time to discharge with the use of these techniques when compared with other interventional modalities. In addition, there appears to be fewer adverse effects with these blocks than with narcotic pain medication.…”

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confidence: 99%

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Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy

Christensen¹,

Polmear

Salfiti³

et al. 2020

Am J Sports Med

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Background: Hip arthroscopy has become the standard for the operative treatment of symptomatic femoroacetabular impingement. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge. Purpose/Hypothesis: Our purpose was to perform a single-blinded randomized controlled trial comparing the use of pericapsular injection versus lumbar plexus blockade for postoperative pain control after arthroscopic surgery on the hip. We hypothesized that pericapsular injection would provide equivalent pain relief to that of lumbar plexus blockade while minimizing adverse effects and alleviating the dependence on a qualified individual to administer. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 64 consecutive patients undergoing hip arthroscopy were prospectively assessed over a 6-month period between 2017 and 2018. Patients were randomly allocated to 1 of 2 groups: 32 patients received a lumbar plexus blockade by a single anesthesiologist, while 32 patients received a pericapsular injection of 30 mL of ropivacaine and 12 mg of morphine. Postoperative pain in the postanesthesia care unit (PACU) as measured using the numeric rating scale, time to discharge, PACU morphine equivalents, and adverse effects were collected by PACU staff. Postoperative day 1 and 2 narcotic use was obtained through a telephone call with the patient on postoperative day 3. Results: We found no statistically significant difference in PACU pain scores at all time points, although there was a trend toward lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not vary across the 2 arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention. Conclusion: Pericapsular injection provides equivalent analgesia when compared with lumbar plexus blockade. It is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy. Registration: ClinicalTrials.gov ID: NCT03244631.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy

Christensen¹,

Polmear

Salfiti³

et al. 2020

Am J Sports Med

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“…Badiola et al 2 determined that FIB was not inferior to LPB in terms of reducing PACU pain scores and that both methods are viable options to help reduce pain after hip arthroscopy. Purcell et al 29 reported that FIB with liposomal bupivacaine and plain bupivacaine did not statistically lower pain scores when compared with FIB with plain bupivacaine only but that decreases in pain scores were observed in both cohorts postoperatively. Xing et al 38 found that VAS pain scores were significantly increased for patients who received placebo instead of FNB and that FNB can provide early pain control; however, patients who received FNB had significantly more falls than the placebo group.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 14 randomized controlled trials z (RCTs) were included in the final qualitative analysis ( Figure 1); 9 (64.3%) were published within the past 5 years. § A variety of analgesia interventions were studied (Table 1): 4 (28.6%) evaluated the use of FIBs 2,5,11,29 ; 3 (21.4%), celecoxib 15,40,41 ; 2 (14.3%), FNBs 37,38 ; 1 (7.1%), periacetabular injections 31 ; 1 (7.1%), extracapsular injections 28 ; 1 (7.1%), intra-articular injections alone 23 ; 1 (7.1%), portal site injections 3 ; and 1 (7.1%), lumbar plexus blocks (LPBs). 39 A total of 9 (64.3%) studies reported on the outcomes of patients who underwent hip arthroscopy for FAI syndrome (FAIS), while the remaining studies included hip arthroscopy for other causes in addition to FAIS or did not specifically report the included procedures.…”

Section: Study Characteristics and Interventionsmentioning

confidence: 99%

Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials

et al. 2020

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Background: Patients who undergo hip arthroscopy inevitably experience pain postoperatively; however, the efficacy and safety of adjunct analgesia to prevent or reduce pain are not well-understood. Purpose: To perform a comprehensive qualitative synthesis of available randomized controlled trials evaluating the effect of adjunct analgesia on postoperative (1) pain, (2) opioid use, and (3) length of stay (LOS) in patients undergoing hip arthroscopy. Study Design: Systematic review. Methods: PubMed, OVID/MEDLINE, and Cochrane Controlled Register of Trials were queried for studies pertaining to analgesia interventions for patients undergoing hip arthroscopy. Two authors independently assessed article bias and eligibility. Data pertaining to changes in pain scores, additional analgesia requirements, length of hospital stay, and complications were extracted and qualitatively reported. Network meta-analyses were constructed to depict mean pain, opioid use, and LOS among the 3 analgesia categories (blocks, local infiltration analgesia, and celecoxib). Results: Fourteen level 1 studies were included; 12 (85.7%) reported pain reductions in the immediate and perioperative period after hip arthroscopy. Of the 7 studies that assessed an intervention (2 celecoxib, 1 fascia iliaca block, 1 lumbar plexus block, 1 femoral nerve block, 1 intra-articular bupivacaine, 1 extracapsular bupivacaine) versus placebo, more than half reported that patients who received an intervention consumed significantly fewer opioids postoperatively than patients who received placebo (lowest P value = .0006). Of the same 7 studies, 2 reported significantly shortened LOS with interventions, while 4 reported no statistically significant difference in LOS and 1 did not report LOS as an outcome. Conclusion: The majority of studies concerning adjunct analgesia for patients undergoing hip arthroscopy suggest benefits in pain reduction early in the postoperative period. There is mild evidence that adjunct analgesia reduces postoperative opioid use and currently inconclusive evidence that it reduces length of hospital stay. Furthermore, it appears that local infiltration analgesia may provide the greatest benefits in reductions in pain and opioid consumption. We recommend the use of adjunct analgesia in appropriately selected patients undergoing hip arthroscopy without contraindication who are at a high risk of severe postoperative pain.

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Surgical Technique: Arthroscopic 270 Degree Labral Reconstruction Using Iliotibial Band Allograft

Wolff¹

2021

Hip Arthroscopy and Hip Joint Preservation Surgery

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Fascia Iliaca Blockade With the Addition of Liposomal Bupivacaine Versus Plain Bupivacaine for Perioperative Pain Management During Hip Arthroscopy: A Double-Blinded Prospective Randomized Control Trial

Cited by 25 publications

References 24 publications

Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy

Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy

Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials

Surgical Technique: Arthroscopic 270 Degree Labral Reconstruction Using Iliotibial Band Allograft

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