Utility of multimodal analgesia with fascia iliaca blockade for acute pain management following hip arthroscopy

Krych, Aaron J.; Baran, Sean; Kuzma, Scott A.; Smith, Hugh M.; Johnson, Rebecca L.; Levy, Bruce A.

doi:10.1007/s00167-013-2665-y

Cited by 51 publications

(52 citation statements)

References 23 publications

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“…Goitia Arrola et al [20] performed a prospective observational study of 41 patients undergoing total hip replacement surgery, and the FICB was effective in controlling early postoperative pain after surgery. Moreover, Krych et al [21] reported that the FICB decreased the opioid consumption, and provided a high quality of pain relief and high overall patient satisfaction in patients with hip surgery.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

Bang

Chung²,

Jeong³

et al. 2016

Medicine

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Background:The fascia iliaca compartment block (FICB) provides an analgesic effect in patients with femur fractures. However, the postoperative pain after hip surgery is different from that after femur fracture, because of the difference in the degree and location of tissue trauma. Whether FICB provides effective postoperative analgesia in patients undergoing total hip arthroplasty is not well understood. Moreover, there is no prospective randomized study to evaluate FICB as a postoperative analgesia in hemiarthroplasty. Therefore, we performed a randomized and prospective study to determine the effect of FICB after hemiarthroplasty. The objective of this study was to compare the opioid consumption between patients who received intravenous patient-controlled analgesia (PCA) with and without FICB.Methods:Twenty-two patients aged 70 to 90 years who underwent bipolar hemiarthroplasty for femoral neck fracture were recruited and allocated randomly into 2 groups: FICB group (n = 11) and Non-FICB group (n = 11). All patients received spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine. After surgery, the FICB was conducted using a modified technique with 0.2% ropivacaine (40 mL) under ultrasonographic guidance, and the intravenous PCA was administered to patients in both groups in the separate block room. The PCA was set up in the only bolus mode with no continuous infusion. The visual analog scale (VAS) and the opioid consumption were noted at 4, 8, 12, 24, and 48 hours postoperatively.Results:The VAS was similar in both groups. The fentanyl requirement at 4, 8, and 12 hours was low in the FICB group. The total amount of fentanyl required in the first 24 hours was 246.3 μg in the FICB group and 351.4 μg in the Non-FICB group. No patient developed any residual sensory-motor deficit during the postoperative period. Patients in the Non-FICB group had nausea (n = 2), and pruritus (n = 1), and 1 patient had nausea in the FICB group during postoperative 2 days.Conclusion:The FICB has a significant opioid-sparing effect in first 24 hours after hemiarthroplasty. This suggests that FICB is an effective way for multimodal analgesia in hip surgery.

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Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

Bang

Chung²,

Jeong³

et al. 2016

Medicine

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“…[18] included 30 patients who received a fascia iliaca block prior to surgery. There was no control group.…”

Section: Resultsmentioning

confidence: 99%

“…In our analysis two studies evaluated the effect on pain scores of a FIB after hip arthroscopy. In the group of Krych et al [18], 30 consecutive patients received a FIB and all patients left the hospital the same day of surgery, with mean Day 0 reported VAS scores 4.7. This study lacked a control group and multimodal analgesia was used, therefore it cannot be said what the sole effect was of the FIB.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given.

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“…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).…”

Section: Methodsmentioning

confidence: 99%

“…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. Outcome comparison between patients who received PNB and controls in the PACU and 1 day following the procedure are presented in Table 4.…”

Section: Postoperative Painmentioning

confidence: 99%

Outcomes After Peripheral Nerve Block in Hip Arthroscopy

Steinhaus¹,

Rosneck²,

Ahmad³

et al. 2018

Am J Orthop

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Pain control following hip arthroscopy presents a significant clinical challenge, with postoperative pain requiring considerable opioid use. Peripheral nerve blocks (PNBs) have emerged as one option to improve pain and limit the consequences of opioid use. The purpose of this study is to provide a comprehensive review of outcomes associated with PNB in hip arthroscopy. We hypothesize that the use of PNB in hip arthroscopy leads to improved outcomes and is associated with few complications. A systematic review of PubMed, Medline, Scopus, and Embase databases was conducted through January 2015 for English-language articles reporting outcome data, with 2 reviewers independently reviewing studies for inclusion. When available, similar outcomes were combined to generate frequency-weighted means. Six studies met the inclusion criteria for this review, reporting on 710 patients undergoing hip arthroscopy. The mean ages were 37.0 and 37.7 years for the PNB and comparator groups, respectively, with a reported total of 281 (40.5%) male and 412 (59.5%) female patients. Postoperative post-anesthesia care unit (PACU) pain was consistently reduced in the PNB group, with the use of a lower morphine equivalent dose and lower rates of inpatient admission, compared with that in the control groups. Postoperative nausea and/or vomiting as well as PACU discharge time showed mixed results. High satisfaction and few complications were reported. In conclusion, PNB is associated with reductions in postoperative pain, analgesic use, and the rate of inpatient admissions, though similar rates of nausea/vomiting and time to discharge were reported. Current PNB techniques are varied, and future research efforts should focus on examining which of these methods provides the optimal risk-benefit profile in hip arthroscopy.

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Utility of multimodal analgesia with fascia iliaca blockade for acute pain management following hip arthroscopy

Cited by 51 publications

References 23 publications

Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

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

Outcomes After Peripheral Nerve Block in Hip Arthroscopy

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