Original Article| Volume 30, ISSUE 2, P195-201, February 2014

Psychological Distress in Hip Arthroscopy Patients Affects Postoperative Pain Control


      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 of Evidence

      Level IV, case series.
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        • Khanduja V.
        • Villar R.N.
        Arthroscopic surgery of the hip: Current concepts and recent advances.
        J Bone Joint Surg Br. 2006; 88: 1557-1566
        • Baker J.F.
        • Byrne D.P.
        • Hunter K.
        • Mulhall K.J.
        Postoperative opiate requirements after hip arthroscopy.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1399-1402
        • Baker J.F.
        • McGuire C.M.
        • Byrne D.P.
        • Hunter K.
        • Eustace N.
        • Mulhall K.J.
        Analgesic control after hip arthroscopy: A randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.
        Hip Int. 2011; 21: 373-377
        • Schroeder K.M.
        • Donnelly M.J.
        • Anderson B.M.
        • Ford M.P.
        • Keene J.S.
        The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy: A retrospective review.
        Hip Int. 2013; 23: 93-98
        • Ward J.P.
        • Albert D.B.
        • Altman R.
        • Goldstein R.Y.
        • Cuff G.
        • Youm T.
        Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?.
        Arthroscopy. 2012; 28: 1064-1069
        • YaDeau J.T.
        • Tedore T.
        • Goytizolo E.A.
        • et al.
        Lumbar plexus blockade reduces pain after hip arthroscopy: A prospective randomized controlled trial.
        Anesth Analg. 2012; 115: 968-972
        • Lee E.M.
        • Murphy K.P.
        • Ben-David B.
        Postoperative analgesia for hip arthroscopy: Combined L1 and L2 paravertebral blocks.
        J Clin Anesth. 2008; 20: 462-465
        • Gatchel R.J.
        • Polatin P.B.
        • Mayer T.G.
        The dominant role of psychosocial risk factors in the development of chronic low back pain disability.
        Spine. 1995; 20: 2702-2709
        • Vranceanu A.M.
        • Barsky A.
        • Ring D.
        Psychosocial aspects of disabling musculoskeletal pain.
        J Bone Joint Surg Am. 2009; 91: 2014-2018
        • Trief P.M.
        • Ploutz-Snyder R.
        • Fredrickson B.E.
        Emotional health predicts pain and function after fusion: A prospective multicenter study.
        Spine. 2006; 31: 823-830
        • Block A.R.
        • Ohnmeiss D.D.
        • Guyer R.D.
        • Rashbaum R.F.
        • Hochschuler S.H.
        The use of presurgical psychological screening to predict the outcome of spine surgery.
        Spine J. 2001; 1: 274-282
        • Trief P.M.
        • Grant W.
        • Fredrickson B.E.
        A prospective study of psychological predictors of lumbar surgery outcome.
        Spine. 2000; 25: 2616-2621
        • Main C.J.
        • Wood P.L.
        • Hollis S.
        • Spanswick C.C.
        • Waddell G.
        The distress risk assessment method: A simple patient classification to identify distress and evaluate the risk of poor outcome.
        Spine. 1992; 17: 42-52
        • Deyo R.A.
        • Walsh N.E.
        • Schoenfel L.S.
        • Ramamurthy S.
        Studies of the modified somatic perceptions questionnaire (MSPQ) in patients with back pain: Psychometric and predictive properties.
        Spine. 1989; 14: 507-510
        • Sharma S.
        • Iorio R.
        • Specht L.M.
        • Davies-Lepie S.
        • Healy W.L.
        Complications of femoral nerve block for total knee arthroplasty.
        Clin Orthop Relat Res. 2010; 468: 135-140
        • Auroy Y.
        • Benhamou D.
        • Bargues L.
        • et al.
        Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service.
        Anesthesiology. 2002; 97: 1274-1280
        • Loubert C.
        • Williams S.R.
        • Helie F.
        • Arcand G.
        Complication during ultrasound-guided regional block: Accidental intravascular injection of local anesthetic.
        Anesthesiology. 2008; 108: 759-760
        • Davis J.D.
        • Swenson J.D.
        • Kelly S.
        • et al.
        Anatomic changes in the inguinal region after hip arthroscopy: Implications for femoral nerve block.
        J Clin Anesth. 2012; 24: 590-592
        • Griffen D.R.
        • Villar R.N.
        Complications of arthroscopy of the hip.
        J Bone Joint Surg Br. 1999; 81: 604-606