The Effect of Intra-articular Cocktail Versus Femoral Nerve Block for Patients Undergoing Hip Arthroscopy.

Abstract

PURPOSE:

To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery.

METHODS:

An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Demographic data, perioperative pain scores, narcotic consumption, incidence of falls, and iatrogenic peripheral neuritis were collected for analysis. Postoperative data were then collected at routine clinical visits.

RESULTS:

A total of 193 patients were included in this study (65 males, 125 females). Of them, 105 patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular "cocktail." There were no significant differences in patient demographics, history of chronic pain (P = .35), worker's compensation (P = .24), preoperative pain scores (P = .69), or intraoperative doses of narcotics (P = .40). Patients who received preoperative femoral nerve blocks reported decreased pain during their time in PACU (P = .0001) and on hospital discharge (P = .28); however, there were no statistically significant differences in patient-reported pain scores at postoperative weeks 1 (P = .34), 3 (P = .64), and 6 (P = .70). Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P = .009) and iatrogenic peripheral neuritis (P = .0001).

CONCLUSIONS:

Preoperative femoral nerve blocks are associated with decreased immediate postoperative pain, whereas intraoperative intra-articular anesthetic injections provide effective postoperative pain control in patients undergoing arthroscopic hip surgery and result in a significant reduction in the rate of postoperative falls and iatrogenic peripheral neuritis.

LEVEL OF EVIDENCE:

Level III, retrospective comparative study.

• Authors: Sean Childs, Sonia Pyne, Kiritpaul Nandra, Wajeeh Bakhsh, S Atif Mustafa, Brian D Giordano
• Journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (Arthroscopy) Vol. 33 Issue 12 Pg. 2170-2176 (Dec 2017) ISSN: 1526-3231 [Electronic] United States
• PMID: 28866348 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Chemical References

• Amides
• Anesthetics, Local
• Anti-Inflammatory Agents, Non-Steroidal
• Drug Combinations
• Narcotics
• Morphine
• Ropivacaine
• Epinephrine
• Ketorolac

Topics

• Accidental Falls (statistics & numerical data)
• Adolescent
• Adult
• Aged
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Anti-Inflammatory Agents, Non-Steroidal
• Arthroscopy (adverse effects, methods)
• Drug Combinations
• Epinephrine (administration & dosage)
• Female
• Femoral Nerve (surgery)
• Hip Joint (surgery)
• Humans
• Injections, Intra-Articular
• Ketorolac (administration & dosage)
• Male
• Middle Aged
• Morphine (administration & dosage)
• Narcotics (administration & dosage)
• Nerve Block (methods)
• Neuritis (epidemiology, etiology)
• Pain Measurement
• Pain, Postoperative (epidemiology, therapy)
• Retrospective Studies
• Ropivacaine
• Treatment Outcome
• Young Adult