The Analgesic Impact of Preoperative Lumbar Plexus Blocks for Hip Arthroscopy. A Retrospective Review

Abstract

This study aimed to examine the impact of preoperative lumbar plexus blockade on perioperative analgesia and opioid consumption following hip arthroscopy. The records of patients (n = 236) who underwent hip arthroscopy between July 27, 2004 and November 15, 2009 were reviewed (118 patients with preoperative lumbar plexus block and 118 procedure matched patients without a preoperative block). Baseline patient characteristics were similar between groups. Immediate post-anaesthesia care unit (PACU) pain scores, peak PACU pain scores, perioperative opioid administration, and PACU antiemetic administration favoured preoperative block placement. Postoperative modified Harris Hip scores and postoperative day one pain scores were similar between groups. Total hospital time following the surgical procedure was longer in the block group. While preoperative lumbar plexus blockade may be helpful for analgesia following hip arthroscopy, more research needs to be done to determine the ideal analgesic regimen for these patients.

Perioperative pain management in hip arthroscopy; what options are there?

“…Schroeder et al [21] determined the effect of an LBP versus general anesthesia in a retrospective series of 236 patients. Lumbar plexus blocks were performed in a room dedicated to regional anesthesia techniques.…”

“…In the study of YaDeau et al [17], LPB significantly reduced pain scores in the PACU, it is questionable if this difference is clinically relevant since pain scores were similar in both groups 4 h after surgery. Schroeder et al [21] reported in their retrospective review significantly lower immediate and peak PACU pain scores in the LPB group. Unfortunately, no separate VAS scores were measured over a longer period of time.…”

Outcomes After Peripheral Nerve Block in Hip Arthroscopy

“…For all 6 included studies, [16][17][18][27][28][29] data were collected regarding the study specifics, patients included, and outcomes measured in the study. The journal of publication, type of study, level of evidence, and type of PNB, as well as the presence of a comparator group were noted ( Table 2).…”

“…This significant difference did not persist at 24 hours or 6 months after the procedure, nor did it exist for pain with movement at any time point. Similarly, Schroeder and colleagues 17 examined patients receiving general anesthesia and lumbar plexus block and found a significant reduction in pain immediately postoperatively in the PACU, though these effects disappeared the day following the procedure. Krych and colleagues 27 also reported on postoperative pain in patients undergoing fascia iliaca blockade, although they did not include a comparator group.…”

“…15 Several pain control strategies have been employed in patients undergoing hip arthroscopy. General anesthesia 16,17 and combined spinal epidural (CSE) 18 are commonly used. However, such techniques rely heavily on opioids for postoperative pain control, 11 and epidural anesthesia commonly requires adjunctive treatments (eg, neuromuscular blockade) to ensure muscle relaxation for joint distraction.…”