Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy

Turner, Elizabeth H.G.; Whalen, Christopher; Beilfuss, Matthew A.; Hetzel, Scott; Schroeder, Kristopher M.; Spiker, Andrea M.

doi:10.1016/j.arthro.2020.08.032

Cited by 19 publications

(5 citation statements)

References 24 publications

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“…17 In a more recent study, neuraxial anesthesia showed a remarkable 42% decrease in opioid consumption in the PACU. 18 However, our study we show an 84% decrease in opioids administered in the PACU with PENG block and BKK injection. There was minimal difference between the GA group and the GA/Marcaine group raising the possibility that the larger effect seen in our results is due to the PENG block as opposed to the periarticular BKK injection.…”

Section: Discussionmentioning

confidence: 47%

A Novel Approach to Improving Post-Operative Pain and Minimizing Opioid Consumption After a Hip Arthroscopy

Widmeyer¹,

Satalich²,

Protzuk³

et al. 2023

Orthopedic Reviews

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Background There have been many different approaches to controlling pain in patients undergoing hip arthroscopy. These include medications, nerve blocks, and intra-articular injections among many others. We introduced a combination of a pre-operative pericapsular nerve group (PENG) block, and intra-operative pericapsular injection of BKK (bupivacaine, ketamine, and ketorolac). Methods Patients undergoing primary hip arthroscopy were identified. There were three patient cohorts based on type of anesthesia: general anesthesia only (GA), general anesthesia and a pericapsular Marcaine injection (GA/Marcaine), or GA with pre-operative PENG block and an intraoperative BKK pericapsular injection (GA+PENG/BKK). Data collected included post-operative pain scores in the PACU (Post-Anesthesia Care Unit), time spent in the PACU, inpatient opioid consumption (both PACU and inpatient), and outpatient opioid prescriptions filled. Results 20 patients received GA, 11 patients received GA/Marcaine, and 20 patients received GA+PENG/BKK. The GA+PENG/BKK group had average PACU pain score of 3.9 out of 10 compared to 7.7 in the GA group (p<.001) and 6.6 in the GA/Marcaine injection group (p=.048). The GA+PENG/BKK group had shorter mean PACU times than either other group (p<.001). The GA+PENG/BKK also consumed less opioids than the GA or GA/Marcaine groups in the PACU (p<.001), and in the total inpatient stay (p=.002, p=.003), as well as outpatient (p=.019, p=.040) Conclusion In patients undergoing a hip arthroscopy, performing a pre-operative PENG block and intra-operative BKK pericapsular injection will result in decreased postoperative pain, PACU time, and inpatient and outpatient opioids compared to general anesthesia only and general anesthesia with intracapsular Marcaine.

show abstract

Section: Discussionmentioning

confidence: 47%

A Novel Approach to Improving Post-Operative Pain and Minimizing Opioid Consumption After a Hip Arthroscopy

Widmeyer¹,

Satalich²,

Protzuk³

et al. 2023

Orthopedic Reviews

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“…General anaesthesia with tracheal intubation is offered as a second option if spinal anaesthesia is contraindicated or if the patient requests general anaesthesia. Our preference for spinal anaesthesia for hip surgery stems from the potential for decreased opioid administration and improved pain control in the peri‐operative period [6]. We recognise, however, that there is no clear consensus in the literature whether either technique results in improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation

Tseng,

Al‐Saidi,

Channagiri

2023

Anaesthesia Reports

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SummaryMany patients with orthotopic heart transplantation later undergo non‐cardiac surgery. Historically, neuraxial anaesthesia has been avoided in these patients because the denervated heart is unable to compensate for hypotension via the baroreceptor reflex. Here, we present the cases of two patients with prior heart transplantation who underwent total hip arthroplasty under spinal anaesthesia with intravenous sedation. In both cases, this technique was well‐tolerated haemodynamically. We propose that spinal anaesthesia with intravenous sedation can be a safe and efficacious anaesthetic technique for selected patients with a history of orthotopic heart transplantation, with careful intraoperative fluid and pharmacological management.

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“…Despite this beneficial effect, regional anesthesia can add blood flow reduction to various tissues, as it can lead to sympathectomy due to spinal cord levels blocked by local anesthetics very commonly used. This effect can be accentuated by drugs administered in general anesthesia (inhalation agents and inducers) [3].…”

Section: Letter To the Editormentioning

confidence: 99%

Combined general and epidural anesthesia without local anesthetic and venous analgesics: original article of technique

Meinberg

2022

MedNEXT

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Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy

Cited by 19 publications

References 24 publications

A Novel Approach to Improving Post-Operative Pain and Minimizing Opioid Consumption After a Hip Arthroscopy

A Novel Approach to Improving Post-Operative Pain and Minimizing Opioid Consumption After a Hip Arthroscopy

Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation

Combined general and epidural anesthesia without local anesthetic and venous analgesics: original article of technique

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