Advertisement

Peripheral Nerve Block for Hip Arthroscopy Does Not Have any Clinical Advantage Compared With Local Anesthetic Regarding Pain Management: A Meta-analysis of Randomized Controlled Trials

Published:December 14, 2021DOI:https://doi.org/10.1016/j.arthro.2021.12.011

      Purpose

      To evaluate the efficacy of peripheral nerve block on reduction in opioid consumption and pain control after hip arthroscopy.

      Method

      To identify studies evaluating the effects of peripheral nerve block on pain control and reduction in opioid consumption in hip arthroscopy, we searched all records in the PubMed, Embase, and Cochrane Library databases until May 2021. Studies with the following characteristics were considered eligible: 1) patients who underwent a hip arthroscopy (population); 2) patients who received peripheral nerve block (intervention); 3) patients who did not receive peripheral nerve block (comparator); 4) record of total opioid consumption as a primary outcome and pain level at 1, 3 to 6, and 24 hours after surgery, patient satisfaction, and incidence of nausea and vomiting as secondary outcomes (outcomes); and 5) randomized controlled trial (study design). Data were independently extracted by two reviewers and synthesized using a random or fixed-effects model, according to the heterogeneity.

      Results

      Eight RCTs were finally included in the meta-analysis. There were no significant differences in postoperative opioid consumption at 24 hours (standardized mean difference [SMD] = −0.091, 95% confidence interval [CI] [−0.270, 0.089]) or in visual analog scale (VAS) score at 1 (SMD = 0.299, 95% CI [−0.758, 0.160]), 3 to 6 (SMD = −0.304, 95% CI [−0.655, 0.047]), and 24 (SMD = −0.230, 95% CI [−0.520, 0.060]) hours postoperatively between the peripheral nerve block and control groups. Moreover, no significant differences were observed in patient satisfaction (SMD < 0.001, 95% CI [−0.284, 0.284]) or the incidence of nausea and vomiting (SMD = 0.808, 95% CI [0.311, 2.104]) between the two groups.

      Conclusion

      Peripheral nerve block for hip arthroscopy has no clinical advantage regarding pain management after surgery when compared with the group that received the local infiltration of analgesics without peripheral nerve block.

      Level of Evidence

      Level II, meta-analysis of level I and II randomized controlled trials (RCTs).
      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 access
      One-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 Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Griffin D.W.
        • Kinnard M.J.
        • Formby P.M.
        • McCabe M.P.
        • Anderson T.D.
        Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.
        Am J Sport Med. 2017; 45: 1928-1936
        • Awad M.A.H.
        • Bajwa A.K.
        • Slaunwhite E.
        • Logan K.J.
        • Wong I.H.
        Indications for hip arthroscopy in pediatric patients a systematic review.
        J Hip Preserv Surg. 2019; 6: 304-315
        • Perets I.
        • Rybalko D.
        • Mu B.H.
        • Friedma A.
        • Morgenstern D.R.
        • Domb B.G.
        Hip arthroscopy: extra-articular procedures.
        Hip Int. 2019; 29: 346-354
        • Kandil A.
        • Safran M.R.
        Hip arthroscopy: A brief history.
        Clin Sport Med. 2016; 35: 321
        • Magrill A.C.L.
        • Nakano N.
        • Khanduja V.
        Historical review of arthroscopic surgery of the hip.
        Int Orthop. 2017; 41: 1983-1994
        • LaPorte C.
        • Rahl M.D.
        • Ayeni O.R.
        • Menge T.J.
        Postoperative pain management strategies in hip arthroscopy.
        Curr Rev Musculosket. 2019; 12: 479-485
        • Shin J.J.
        • de Sa D.L.
        • Burnham J.M.
        • Mauro C.S.
        Refractory pain following hip arthroscopy: Evaluation and management.
        J Hip Preserv Surg. 2018; 5: 3-14
        • Kolaczko J.G.
        • Knapik D.M.
        • Salata M.J.
        Peri-operative pain management in hip arthroscopy: A systematic review of the literature.
        J Hip Preserv Surg. 2019; 6: 353-363
        • Shin J.J.
        • McCrum C.L.
        • Mauro C.S.
        • Vyas D.
        Pain management after hip arthroscopy: Systematic review of randomized controlled trials and cohort studies.
        Am J Sport Med. 2018; 46: 3288-3298
        • Min B.W.
        • Kim Y.
        • Cho H.M.
        • et al.
        Perioperative pain management in total hip arthroplasty: Korean hip society guidelines.
        Hip Pelvis. 2016; 28: 15-23
        • Sanzone A.G.
        Current challenges in pain management in hip fracture patients.
        J Orthop Trauma. 2016; 30: S1-S5
        • Wang X.
        • Sun Y.
        • Wang L.
        • Hao X.
        Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty: A meta-analysis from randomized controlled trials.
        Medicine (Baltimore). 2017; 96e7382
        • Rashiq S.
        • Vandermeer B.
        • Abou-Setta A.M.
        • Beaupre L.A.
        • Jones C.A.
        • Dryden D.M.
        Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: Multiple treatment comparison.
        Can J Anaesth. 2013; 60: 230-243
        • Scurrah A.
        • Shiner C.T.
        • Stevens J.A.
        • Faux S.G.
        Regional nerve blockade for early analgesic management of elderly patients with hip fracture. A narrative review.
        Anaesthesia. 2018; 73: 769-783
        • Garner M.
        • Alshameeri Z.
        • Sardesai A.
        • Khanduja V.
        A prospective randomized controlled trial comparing the efficacy of fascia iliaca compartment block versus local anesthetic infiltration after hip arthroscopic surgery.
        Arthroscopy. 2017; 33: 125-132
        • Glomset J.L.
        • Kim E.
        • Tokish J.M.
        • et al.
        Reduction of postoperative hip arthroscopy pain with an ultrasound-guided fascia iliaca block: A prospective randomized controlled trial.
        Am J Sport Med. 2020; 48: 682-688
        • 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
        • Xing J.G.
        • Abdallah F.W.
        • Brull R.
        • et al.
        Preoperative femoral nerve block for hip arthroscopy: A randomized, triple-masked controlled trial.
        Am J Sports Med. 2015; 43: 2680-2687
        • 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
        • Yuan L.
        • Zhang Y.
        • Xu C.
        • Wu A.
        Postoperative analgesia and opioid use following hip arthroscopy with ultrasound-guided quadratus lumborum block: A randomized controlled double-blind trial.
        J Int Med Res. 2020; 48 (300060520920996)
        • Huang M.J.
        • Wages J.J.
        • Henry A.C.
        • Epperson J.M.
        Should preoperative fascia iliaca block be used for hip arthroscopic labral repair and femoroacetabular impingement treatment? A prospective single blinded randomized study.
        Arthroscopy. 2020; 36: 1039-1044
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Rhee S.J.
        • Kim H.J.
        • Lee C.R.
        • Kim C.W.
        • Gwak H.C.
        • Kim J.H.
        A comparison of long-term outcomes of computer-navigated and conventional total knee arthroplasty: A meta-analysis of randomized controlled trials.
        J Bone Joint Surg Am. 2019; 101: 1875-1885
        • Moon N.H.
        • Jang J.H.
        • Shin W.C.
        • Jung S.J.
        Effects of teriparatide on treatment outcomes in osteoporotic hip and pelvic bone fractures: Meta-analysis and systematic review of randomized controlled trials.
        Hip Pelvis. 2020; 32: 182-191
        • Purcell R.L.
        • Brooks D.I.
        • Steelman T.J.
        • et al.
        Fascia iliaca blockade with the addition of liposomal bupivacaine versus plain bupivacaine for perioperative pain management during hip arthroscopy: A double-blinded prospective randomized control trial.
        Arthroscopy. 2019; 35: 2608-2616
        • Skjold C.
        • Møller A.M.
        • Wildgaard K.
        Pre-operative femoral nerve block for hip fracture—A systematic review with meta-analysis.
        Acta Anaesthesiol Scand. 2020; 64: 23-33
        • Arsoy D.
        • Huddleston 3rd, J.I.
        • Amanatullah D.F.
        • Giori N.J.
        • Maloney W.J.
        • Goodman S.B.
        Femoral nerve catheters improve home disposition and pain in hip fracture patients treated with total hip arthroplasty.
        J Arthroplasty. 2017; 32: 3434-3437
        • Gupta M.
        • Kamath S.S.
        Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: An observational study.
        Korean J Pain. 2020; 33: 138-143
        • Steenberg J.
        • Moller A.M.
        Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation.
        Br J Anaesth. 2018; 120: 1368-1380
        • Zhang X.Y.
        • Ma J.B.
        The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: a meta-analysis.
        J Orthop Surg Res. 2019; 14: 33
        • Bailey T.L.
        • Stephens A.R.
        • Adeyemi T.F.
        • et al.
        Traction time, force and postoperative nerve block significantly influence the development and duration of neuropathy following hip arthroscopy.
        Arthroscopy. 2019; 35: 2825-2831
        • Philippi M.T.
        • Kahn T.L.
        • Adeyemi T.F.
        • Maak T.G.
        • Aoki S.K.
        Extracapsular local infiltration analgesia in hip arthroscopy: a retrospective study.
        J Hip Preserv Surg. 2018; 5: 60-65
        • Gerbershagen H.J.
        • Aduckathil S.
        • van Wijck A.J.
        • Peelen L.M.
        • Kalkman C.J.
        • Meissner W.
        Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.
        Anesthesiology. 2013; 118: 934-944