Purpose
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.
Methods
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.
Results
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).
Conclusions
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 of Evidence
Level IV, case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthroscopic surgery of the hip: Current concepts and recent advances.J Bone Joint Surg Br. 2006; 88: 1557-1566
- Postoperative opiate requirements after hip arthroscopy.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1399-1402
- Analgesic control after hip arthroscopy: A randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.Hip Int. 2011; 21: 373-377
- The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy: A retrospective review.Hip Int. 2013; 23: 93-98
- Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?.Arthroscopy. 2012; 28: 1064-1069
- Lumbar plexus blockade reduces pain after hip arthroscopy: A prospective randomized controlled trial.Anesth Analg. 2012; 115: 968-972
- Postoperative analgesia for hip arthroscopy: Combined L1 and L2 paravertebral blocks.J Clin Anesth. 2008; 20: 462-465
- The dominant role of psychosocial risk factors in the development of chronic low back pain disability.Spine. 1995; 20: 2702-2709
- Psychosocial aspects of disabling musculoskeletal pain.J Bone Joint Surg Am. 2009; 91: 2014-2018
- Emotional health predicts pain and function after fusion: A prospective multicenter study.Spine. 2006; 31: 823-830
- The use of presurgical psychological screening to predict the outcome of spine surgery.Spine J. 2001; 1: 274-282
- A prospective study of psychological predictors of lumbar surgery outcome.Spine. 2000; 25: 2616-2621
- The distress risk assessment method: A simple patient classification to identify distress and evaluate the risk of poor outcome.Spine. 1992; 17: 42-52
- Studies of the modified somatic perceptions questionnaire (MSPQ) in patients with back pain: Psychometric and predictive properties.Spine. 1989; 14: 507-510
- Complications of femoral nerve block for total knee arthroplasty.Clin Orthop Relat Res. 2010; 468: 135-140
- Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service.Anesthesiology. 2002; 97: 1274-1280
- Complication during ultrasound-guided regional block: Accidental intravascular injection of local anesthetic.Anesthesiology. 2008; 108: 759-760
- Anatomic changes in the inguinal region after hip arthroscopy: Implications for femoral nerve block.J Clin Anesth. 2012; 24: 590-592
- Complications of arthroscopy of the hip.J Bone Joint Surg Br. 1999; 81: 604-606
Article info
Publication history
Accepted:
November 13,
2013
Received:
April 18,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: S.K.A. is an educational consultant for Pivot Medical and ArthroCare.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
