Pre-operative lumbar plexus block provides superior post-operative analgesia when compared with fascia iliaca block or general anesthesia alone in hip arthroscopy

Abstract

The objective of this study is to retrospectively examine the effects of pre-operative fascia iliaca (FI) and lumbar plexus (LPB) nerve blocks on post-operative pain and secondary post-operative variables following arthroscopic surgery of the hip. Subjects undergoing arthroscopic surgery of the hip received one of three pre-operative anesthetic techniques; general anesthesia only, general anesthesia with FI or general anesthesia with LPB. Patient reported pain scores (0–10) were recorded at 0, 30, 60, 90 and 120 min after admission to the post-anesthesia care unit (PACU). Secondary variables examined include time spent in the PACU, morphine equivalent administered, presence of nausea, persistent numbness, parasthesia, weakness, increased narcotic usage for rebound pain, ED visits and hospital admissions. The mean pain scores over all time points were significantly lower in the LPB group (2.38) than the FI group (4.08, P < 0.001) and the Gen group (3.55, P < 0.001). Patients receiving a lumbar plexus block exhibited significantly decreased pain at t = 0 (P = 0.019), t = 30 (P = 0.038), t = 60 (P = 0.013), t = 90 (P = 0.017) and t = 120 (P = 0.001) after admission to PACU. The FI group showed no improvement in any post-operative variable when compared with general anesthesia alone. There was no difference in the time to discharge or in morphine equivalent administered between groups. One patient receiving a lumbar plexus block experienced a seizure lasting about 10 s. However, there were no medium or long-term complications. Lumbar plexus block administered in concert with general anesthesia provides clinically important and statistically significant post-operative pain relief when compared with general anesthesia alone or general anesthesia plus fascia iliaca block.

Reduction of Postoperative Hip Arthroscopy Pain With an Ultrasound-Guided Fascia Iliaca Block: A Prospective Randomized Controlled Trial

“…35 LPBs have also been used effectively for postoperative pain, but they require significant technical expertise and are associated with a significant complication risk. 27,34,36 Schroeder et al 27 performed a retrospective matched-cohort study in which they reviewed the records of patients who underwent hip arthroscopy and received an LPB preoperatively. The peak PACU pain scores were significantly improved in patients receiving an LPB.…”

Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

“…Rebound pain has also been reported in lower limb nerve blocks [14,15,19,73]. Femoral nerve blocks provide effective analgesia for knee surgeries with limitations being rebound pain and increased risks of falls due to quadriceps weakness [19,74,75].…”

“…Wolff et al reported significantly lower pain scores up to 2 h post-operatively in patients undergoing arthroscopic hip surgery under lumbar plexus versus fascia iliaca block [73]. Regardless of pain scores, most of the patients received a standard dose of oxycodone as soon as they could tolerate oral medications.…”

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

“…4 In a previous retrospective review, researchers from our group found lumbar plexus blockade to be superior to fascia iliaca blockade as well as general anesthesia alone. 25 However, lumbar plexus blockade continues to present several concerns, including but not limited to dependence on the experience and comfort level of the administering anesthesiologist, concomitant postoperative motor blockade, postoperative fall risk, and the risk of epidural or intravascular injection. As a result of these concerns, we continued to investigate alternative methods for obtaining optimal postoperative pain control after hip arthroscopy.…”