Intra-Articular Anesthesia Reduces Pain After Arthroscopic Hip Surgery

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Patients who had received postoperative femoral nerve block experienced more falls.
Patients who had received postoperative femoral nerve block experienced more falls.

In addition to preoperative femoral nerve block, the use of intra-articular anesthetic injections during arthroscopic hip surgery may offer effective postprocedural pain relief and be associated with a reduced risk for postoperative falls, according to findings from a retrospective review published in Arthroscopy.1

Investigators reviewed the records of patients who underwent elective arthroscopic hip surgery.

Included patients were stratified into 2 groups: subjects receiving an intra-articular injection following the procedure (n=88), and subjects receiving a femoral nerve block prior to the procedure (n=105). 

During their stay at the postanesthesia care unit, patients receiving the preoperative femoral nerve block reported significantly lower pain scores (assessed with a 0 to 10 visual analog scale) compared with subjects receiving the intra-articular injection (4.59 ± 2.85 vs 6.16 ± 2.56; P <.001).

These differences, however, were not considered significant at postprocedural week 1 (P =.34), 3 (P =.64), or 6 (P =.70). Patients receiving an intra-articular block had significantly lower rates of falls following the procedure (5 vs 19; P <.001) and decreased rates of iatrogenic peripheral neuritis (2 vs 26; P <.001) compared with subjects receiving a femoral nerve block. 

The investigators hypothesize that the increased number of falls in the postoperative femoral nerve block group is likely the result of ambulating patients attempting “to use the postoperative leg to help with balance; however, with the block in place, [they] are unable to appreciate any tactile feedback, resulting in falls.”

Study Limitations

  • The study was retrospective and lacked randomization
  • No blinding was performed for the perioperative pain management strategy

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Reference

  1. Childs S, Pyne S, Nandra K, Bakhsh W, Mustafa SA, Giordano BD. The effect of intra-articular cocktail versus femoral nerve block for patients undergoing hip arthroscopy. Arthroscopy [published online August 30, 2017]. doi: 10.1016/j.arthro.2017.06.036.

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