Lumbar plexus block (LPB) combined with a multimodal analgesic regimen reduced pain on the day of hip arthroscopy surgery and can be considered for reduction of short-term pain.
The indications for hip arthroscopy are rapidly increasing to include both intra- and extra–articular disorders such as femoro-acetabular impingement, synovial disorders, abductor pathology, etc. These large, complex cases are associated with moderate to severe postoperative pain, and treatment with opioids can result in nausea, vomiting and delayed discharge. Lumbar plexus blockade (LPB) has a low complication rate and is superior to opioids for pain control after total hip replacement. However, a dearth of literature exists on using LPB for hip arthroscopy. This study investigated whether the addition of LPB to neuraxial anesthesia reduced postoperative pain.
Following IRB approval, 82 patients undergoing ambulatory hip arthroscopy were enrolled in this randomized controlled trial. All patients received intravenous sedation, combined spinal-epidural and postoperative hydrocodone/acetaminophen and oral NSAIDs. Study patients additionally received LPB using 30 mL 0.25% bupivacaine (with 5 mcg/ml epinephrine) following quadriceps stimulation. A blinded investigator interviewed patients at 0.5, 1, 2, 3 and 4 hours postoperatively, and via telephone the following day.
Demographics were uniform between groups. Using the General Estimating Equations method, the LPB was shown to reduce pain at rest in the PACU (mean NRS 3.3±2.2 for LPB versus 4.2±1.8 for CSE-only patients). Non-significant trends in analgesic usage (21mg oral morphine equivalents vs. 29mg), pain with movement (NRS of 4.0 vs. 5.0), and patient satisfaction (8.6/10 vs. 7.9/10) also favored the intervention. There were no associated neurovascular complications from the LPB but there were two falls in the LPB group, without injury.
Discussion and Conclusion
LPB combined with a multimodal analgesic regimen reduced pain on the day of hip arthroscopy surgery and can be considered for reduction of short-term pain. The absence of significant improvement in secondary outcomes suggests that risk-benefit assessment of LPB for hip arthroscopy patients should be individualized.
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.