The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy. A retrospective review

Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Wisconsin - USA.
Hip international: the journal of clinical and experimental research on hip pathology and therapy (Impact Factor: 0.76). 01/2013; 23(1). DOI: 10.5301/HIP.2013.10613
Source: PubMed


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.

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    ABSTRACT: To determine whether patients with higher levels of preoperative psychological distress more frequently use a postoperative fascia iliaca nerve block for pain control after hip arthroscopy, and to determine whether a fascia iliaca nerve block is an effective adjunct to multimodal oral and intravenous analgesia after hip arthroscopy. One hundred seven patients undergoing hip arthroscopy were prospectively enrolled. Before surgery, patients were administered the Distress Risk Assessment Method questionnaire to quantify their level of preoperative psychological distress. Postoperatively, patients with pain inadequately controlled by multimodal oral and intravenous analgesics could request and receive a fascia iliaca nerve block. Pain scores, opioid consumption, time in the post-anesthesia care unit (PACU), and postoperative complications were recorded for all patients. Patients with normal Distress Risk Assessment Method scores requested fascia iliaca nerve blocks approximately half as frequently (18 of 50 [36%]) as patients in the at-risk category (28 of 47 [60%]) or distressed category (7 of 10 [70%]) (P = .02). Patients with high levels of distress also received 40% more intraoperative opioid than patients with normal scores (P = .04). In the study population as a whole, patients who received a fascia iliaca nerve block (n = 53) had a higher initial visual analog scale (VAS) pain score in the PACU (7.2 ± 0.3 v 5.5 ± 0.4, P = .001) and showed greater improvement in the VAS pain score by PACU discharge (-4.3 ± 0.2 v -2.1 ± 0.3, P ≤ .0001) compared with patients who did not receive a block (n = 54). Patients with higher levels of preoperative psychological distress more frequently requested a postoperative nerve block to achieve adequate pain control after hip arthroscopy. Patients receiving a block had greater improvement in VAS pain scores compared with patients managed with oral and intravenous analgesics alone. Level IV, case series.
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