ePoster #117 - ISHA Annual Scientific Meeting 2016

Intra-Articular “Cocktail” Offers Clinical Advantages Over Femoral Nerve Block For Postoperative Analgesia In Patients Undergoing Arthroscopic Hip Surgery

Sean M. Childs, MD, Rochester, NY UNITED STATES
Sonia Pyne, MD, Rochester, NY UNITED STATES
Kiritpaul Nandra, MD, Rochester, NY UNITED STATES
S. Atif Mustafa, BS, Rochester, NY UNITED STATES
Wajeeh Bakhsh, MD, Rochester, NY UNITED STATES
Amy Lalonde, MA, Rochester, NY UNITED STATES
Derick Peterson, PhD, Rochester, NY UNITED STATES
Brian D. Giordano, MD, Rochester, NY UNITED STATES

University of Rochester, Rochester, NY, UNITED STATES

FDA Status Not Applicable

Summary: Reduced risk of falls and neuritis with intra-articular block administration following arthroscopic hip surgery

Abstract:
Background/Purpose: Arthroscopic hip surgery has gained considerable popularity over the past several years. Attempts to optimize peri and postoperative pain control continues to represent a challenge and opportunity for clinical improvement. Multiple regional anesthesia strategies have been utilized by arthroscopic hip surgeons, including lumbar plexus and femoral nerve blockade, however these options can be associated with setbacks including technical difficulty, intravascular injection, increased post-operative fall risk and the development of peripheral neuritis. Therefore, exploration of alternative regional anesthesia strategies holds promise for improved clinical outcomes. This study aims to explore the efficacy and complication rate of intra-articular anesthetic administration in patients undergoing arthroscopic hip surgery. Methods: A retrospective analysis of prospectively collected data was conducted to identify all patients undergoing elective arthroscopic hip surgery between November 2013 and April 2015. Subjects were stratified into either a group that had received a preoperative femoral nerve block for perioperative pain control or a group that had an intra-articular injection of local anesthetic administered by the surgical team intraoperatively. Objective data, including pre and post-op pain scores in the PACU, total dose of narcotics required perioperatively, occurrence of falls and development of peripheral neuropathy were collected for analysis. Data was compared between the two groups using linear and logistic regression modeling. Statistical significance was determined as p<0.05. Results: A total of 193 patients were included in this study (65 males, 125 females). One hundred five patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular “cocktail” at the conclusion of their procedure. Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P<0.01) and iatrogenic peripheral neuritis (P<0.01). There was no significant difference between the two groups with regards to age, sex, smoking status, history of chronic pain, worker’s compensation, preoperative pain scores or intraoperative doses of narcotics. Additionally, there were no statistically significant differences in patient reported pain scores at postoperative weeks 1, 3 or 6. Conclusions: Intra-articular anesthetic administration was found to be similar in efficacy to pre-operative femoral nerve blocks at reducing post-operative pain in patients undergoing hip arthroscopy. Additionally, patients receiving intra-articular injections had a significantly decreased risk of falling post-operatively or developing peripheral neuritis, known complications of femoral nerve blocks. With this information, intra-articular anesthetic administration appears to be a safe alternative to femoral nerve blocks in patients undergoing hip arthroscopy.