Pragmatic comparative effectiveness study of multimodal fascia iliaca nerve block and continuous lumbar epidural-based protocols for periacetabular osteotomy

Albertz, Megan; Whitlock, Patrick W.; Fang, Yang; Ding, Lili; Uchtman, Molly; Mecoli, Marc; Olbrecht, Vanessa A.; Moore, David L.; McCarthy, James J.; Chidambaran, Vidya

doi:10.1093/jhps/hnab010

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…Fascia iliacus block has also been described following PAO. Albertz et al compared 16 patients with a fascia iliacus block to 16 patients with an epidural following PAO for AD [ 18 ]. The fascia iliacus block group had significantly shorter LOS and lower MME.…”

Section: Discussionmentioning

confidence: 99%

Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Ellis¹,

Harris²,

Flemming³

et al. 2023

Cureus

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Introduction: Previous studies have evaluated the effect of the pericapsular nerve group block for hip arthroscopy and the transverse abdominis plane block for periacetabular osteotomy and have shown decreased narcotic consumption in both groups. No published study has evaluated the effectiveness of combining the blocks when performing hip arthroscopy and periacetabular osteotomy under the same general anesthesia. It was hypothesized that patients treated for hip dysplasia with hip arthroscopy and concomitant periacetabular osteotomy using a pericapsular nerve group block, transverse abdominis plane block, and general anesthesia would have decreased postoperative pain and require less narcotic consumption than those undergoing the procedure with general anesthetic alone.Methods: A single surgeon performed a retrospective analysis of consecutive patients undergoing concomitant hip arthroscopy and periacetabular osteotomy between 11/2020 and 6/2021. Fifteen consecutive patients undergoing the procedure with a general anesthetic alone (no-block group) were compared to 15 patients undergoing the same procedure with a combined pericapsular nerve group block, transverse abdominis plane block, and general anesthetic (block group). Hip arthroscopy was performed utilizing a post-free technique, and a rectus sparing approach was used for the periacetabular osteotomy. The nerve blocks were performed by multiple anesthesiologists using previously published methods. Operating room time, length of stay, visual analog scale pain scores, and total narcotic consumption in morphine milliequivalents were analyzed. Groups were compared using the chi-squared test for noncontinuous demographic variables and a two-tailed t-test for continuous variables utilizing Microsoft Excel (Microsoft, Redmond, WA, USA), p-value set at 0.05 for significance.Results: The no-block group consisted of 14 females and one male, while the block group was all females. No significant differences were observed between age, sex, BMI, surgery time, length of stay, or procedures performed, p>0.05. The maximal visual analog scale score in the post-anesthesia care unit was 8 ± 1.3 vs. 7 ± 1.9 in the no-block vs. block groups, respectively, p=0.15. The average hospital floor visual analog scale score was 5.7 ± 1.3 vs. 4.8 ± 1.3 in the no-block vs. block groups, respectively, p=0.07. Total pain medications required were 217.6 ± 54.6 vs. 154 ± 41.9 morphine milliequivalents in the no-block vs. block groups, respectively, p=0.001. No complications were reported in either group, and no patient in the block group demonstrated motor nerve palsy or postoperative fall.Conclusion: This study demonstrated that patients undergoing combined hip arthroscopy and periacetabular osteotomy for symptomatic acetabular dysplasia who had pericapsular nerve group, transverse abdominal plane block, and general anesthesia required fewer narcotics in the first 24 hours after surgery compared to those who had general anesthesia alone.

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Section: Discussionmentioning

confidence: 99%

Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Ellis¹,

Harris²,

Flemming³

et al. 2023

Cureus

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“…Figure 2 b includes a summary of the major findings from the evidence available for genetic and epigenetic contributions to chronic pain in children and adolescents (see the Supplementary File for search terms). Chidambaran et al (2020) conducted a systematic review and meta-analysis on genetic risk associated with the development of chronic postsurgical pain in humans [ 152 ]. Their meta-analysis included 21 full-text articles, of which only one study included pediatric age ranges.…”

Section: State-of-the-art Reviewmentioning

confidence: 99%

Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum

Duff

Krolick

Mahmoud

et al. 2023

JCM

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Chronic pain is highly prevalent in the pediatric population. Many factors are involved in the transition from acute to chronic pain. Currently, there are conceptual models proposed, but they lack a mechanistically sound integrated theory considering the stages of child development. Objective biomarkers are critically needed for the diagnosis, risk stratification, and prognosis of the pathological stages of pain chronification. In this article, we summarize the current evidence on mechanisms and biomarkers of acute to chronic pain transitions in infants and children through the developmental lens. The goal is to identify gaps and outline future directions for basic and clinical research toward a developmentally informed theory of pain chronification in the pediatric population. At the outset, the importance of objective biomarkers for chronification of pain in children is outlined, followed by a summary of the current evidence on the mechanisms of acute to chronic pain transition in adults, in order to contrast with the developmental mechanisms of pain chronification in the pediatric population. Evidence is presented to show that chronic pain may have its origin from insults early in life, which prime the child for the development of chronic pain in later life. Furthermore, available genetic, epigenetic, psychophysical, electrophysiological, neuroimaging, neuroimmune, and sex mechanisms are described in infants and older children. In conclusion, future directions are discussed with a focus on research gaps, translational and clinical implications. Utilization of developmental mechanisms framework to inform clinical decision-making and strategies for prevention and management of acute to chronic pain transitions in children, is highlighted.

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“…Postoperative pain control is particularly crucial in this group of patients who often undergo extensive surgery, such as bilateral proximal femoral and pelvic osteotomies as well as additional soft tissue releases. 1,10,11 The Institute of Medicine released a report in 2003 titled Unequal Treatment: Confronting Race and Ethnic Disparities in Healthcare which concluded that "Racial and ethnic disparities in healthcare exist, and because they are associated with worse outcomes in many cases, are unacceptable." 15 Hidden and often unintentional bias can affect our perspective and patient care.…”

Section: Pain Medication and Delivery To Underrepresented Minoritiesmentioning

confidence: 99%

Racial Inequalities in the Delivery of Pain Medication in Pediatric Orthopaedics and a Call to Action

McCarthy¹,

Kelley²,

Crawford³

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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The murder of George Floyd and subsequent racial unrest has motivated our country to re-examine issues of racial justice, equity, diversity, and inequality in every sphere of society. Healthcare is not spared from this self-examination. Racial disparities in the United States healthcare system are endemic and persistent throughout medical and surgical specialties.4,6,7 These disparities can manifest as lack of access, delays in diagnosis and care, and poor health outcomes.2,16

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Pragmatic comparative effectiveness study of multimodal fascia iliaca nerve block and continuous lumbar epidural-based protocols for periacetabular osteotomy

Cited by 8 publications

References 43 publications

Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum

Racial Inequalities in the Delivery of Pain Medication in Pediatric Orthopaedics and a Call to Action

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