Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy

Published:November 17, 2020DOI:


      We sought to identify the immediate postoperative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure.


      Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were reviewed retrospectively. The primary outcome was PACU opioid administration, measured by morphine equivalents. Secondary parameters included total LOS, postincision LOS, PACU LOS, and PACU arrival/discharge pain scores. Analyses conducted were t tests, Wilcoxon rank sum tests, or χ2 tests.


      A total of 129 patients met inclusion criteria for this study; 54 male and 75 female, with an average age of 28 (±10.1) years. In total, 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia, which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower morphine equivalents in both the operating room (30.0 vs 53.9, P = .001) and PACU (18.2 vs 31.2, P = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, P = .001, 3.0 vs. 4.0, P = .013). There was no statistically significant difference in postincision LOS or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs 1.3 hours, P = .005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group.


      Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared with general anesthesia.

      Level of Evidence

      III, Retrospective Comparative Study
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        • Magrill A.C.L.
        • Nakano N.
        • Khanduja V.
        Historical review of arthroscopic surgery of the hip.
        Int Orthop. 2017; 41: 1983-1994
        • Yu H.C.
        • Al-Shehri M.
        • Johnston K.D.
        • Endersby R.
        • Baghirzada L.
        Anesthesia for hip arthroscopy: A narrative review.
        Can J Anesth. 2016; 63: 1277-1290
        • Byrd J.W.T.
        Chapter 53: Hip arthroscopy for nonstructural hip problems.
        (Accessed August 17, 2020)
        • Weidenhielm E.J.F.R.W.
        Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia.
        Arthroscopy. 2000; 16: 183-190
        • Mulroy M.F.
        • Larkin K.L.
        • Hodgson P.S.
        • Helman J.D.
        • Pollock J.E.
        • Liu S.S.
        A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy.
        Anesth Analg. 2000; 91: 860-864
        • Liang C.
        • Wei J.
        • Cai X.
        • Lin W.
        • Fan Y.
        • Yang F.
        Efficacy and safety of 3 different anesthesia techniques used in total hip arthroplasty.
        Med Sci Monit. 2017; 23: 3752-3759
        • Chu C.P.W.
        • Yap J.C.C.M.
        • Chen P.P.
        • Hung H.H.
        Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia.
        Hong Kong Med J. 2006; 12: 442-447
        • Singelyn F.J.
        • Deyaert M.
        • Joris D.
        • Pendeville E.
        • Gouverneur J.M.
        Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty.
        Anesth Analg. 1998; 87: 88-92
        • Alrayashi W.
        • Zurakowski D.
        • Sullivan C.A.
        • et al.
        The effect of suprainguinal fascia iliaca block on the recovery of patients after arthroscopic hip surgery.
        Pediatr Anesth. 2019; 29: 829-834
        • Xing J.G.
        • Abdallah F.W.
        • Brull R.
        • et al.
        Preoperative femoral nerve block for hip arthroscopy.
        Am J Sports Med. 2015; 43: 2680-2687
      1. ASA Physical Status Classification System | American Society of Anesthesiologists (ASA).
        • Centers for Disease Control and Prevention
        CDC Guideline for Prescribing Opioids for Chronic Pain.
        • Ead H.
        From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery.
        J Perianesth Nurs. 2006; 21: 259-267
        • Hah J.M.
        • Bateman B.T.
        • Ratliff J.
        • Curtin C.
        • Sun E.
        Chronic opioid use after surgery.
        Anesth Analg. 2017; 125: 1733-1740
        • Clarke H.
        • Soneji N.
        • Ko D.T.
        • Yun L.
        • Wijeysundera D.N.
        Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study.
        BMJ. 2014; 348
        • Trasolini N.A.
        • McKnight B.M.
        • Dorr L.D.
        The opioid crisis and the orthopedic surgeon.
        J Arthroplasty. 2018; 33: 3379-3382.e1
        • Morris B.J.
        • Mir H.R.
        The opioid epidemic: Impact on orthopaedic surgery.
        J Am Acad Orthop Surg. 2015; 23: 267-271
        • Gan T.J.
        • Habib A.S.
        • Miller T.E.
        • White W.
        • Apfelbaum J.L.
        Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey.
        Curr Med Res Opin. 2014; 30: 149-160
        • Ward J.P.
        • Albert D.B.
        • Altman R.
        • Goldstein R.Y.
        • Cuff G.
        • Yourn T.
        Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?.
        Arthrosc J Arthrosc Relat Surg. 2012; 28: 1064-1069
        • Kay J.
        • de SA D.
        • Memon M.
        • Simunocic N.
        • Paul J.
        • Ayeni O.R.
        Examining the role of perioperative nerve blocks in hip arthroscopy: A systematic review.
        Arthrosc J Arthrosc Relat Surg. 2016; 32: 704-715
        • Hah J.
        • Kramer E.
        • Hilmoe H.
        • et al.
        Factors associated with acute pain estimation, postoperative pain resolution, opioid cessation, and recovery: Secondary analysis of a randomized clinical trial.
        JAMA Netw Open. 2019; 2e190168
        • Everhart J.S.
        • Hughes L.
        • Abouljoud M.M.
        • Swank K.
        • Lewis C.
        • Flanigan D.C.
        Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury.
        Knee Surg Sport Traumatol Arthrosc. 2020; 28: 1894-1900
        • 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
        • Behrends M.
        • Yap E.N.
        • Zhang A.L.
        • et al.
        Preoperative fascia iliaca block does not improve analgesia after arthroscopic hip surgery, but causes quadriceps muscles weakness: A randomized, double-blind trial.
        Anesthesiology. 2018; 129: 536-543
        • Pavlin D.J.
        • Rapp S.E.
        • Polissar N.L.
        • Malmgren J.A.
        • Koerschgen M.
        • Keyes H.
        Factors affecting discharge time in adult outpatients.
        Anesth Analg. 1998; 87: 816-826
        • Casati A.
        • Cappelleri G.
        • Aldegheri G.
        • Marchetti C.
        • Messina M.
        • De Ponti A.
        Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy.
        Minerva Anestesiol. 2004; 70: 493-502
        • Harris M.
        • Chung F.
        Complications of general anesthesia.
        Clin Plast Surg. 2013; 40: 503-513
        • Liu H.
        • Brown M.
        • Sun L.
        • et al.
        Complications and liability related to regional and neuraxial anesthesia.
        Best Pract Res Clin Anaesthesiol. 2019; 33: 487-497
        • Weissman D.N.
        • De Perio M.A.
        • Radonovich L.J.
        COVID-19 and risks posed to personnel during endotracheal intubation.
        JAMA. 2020; 323: 2027-2028