Perioperative pain management in hip arthroscopy; what options are there?

Comparison of the Effect of Pericapsular Nerve Group Block Combined with Lateral Femoral Cutaneous Nerve Block and Fascia Iliaca Compartment Block in Patients Undergoing Hip Arthroscopy Under General Anesthesia: A Randomized, Double-Blind Trial

Purpose

Patients undergoing arthroscopic hip surgery (AHS) require good analgesia and early rehabilitation after surgery, and there is no consensus on the optimal nerve block. We aimed to compare the efficacy of the pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve (LFCN) block compared to fascia iliaca compartment block (FICB) in patients with AHS.

Patients and Methods

A total of 80 patients receiving AHS under general anesthesia were randomized to receive either FICB (group F) or PENG block in combination with LFCN block (group P). The primary outcomes were the rate of quadriceps weakness after block on the afflicted side, as well as muscle strength grading and pain score after block, and the quality of recovery on the second postoperative day.

Results

Compared with group F, group P had a lower incidence of quadriceps weakness 48 h after block (76.9% vs 28.2%, P < 0.001), and had less impact on muscle strength grade and lower static pain score at 6, 12, 18, 24, 36, and 48 h after block (P < 0.001), and a lower dynamic pain score at 6 and 12 h after block in group P (p < 0.05). The quality of recovery on the second postoperative day improved (p < 0.05).

Conclusion

In comparison to FICB, PENG block in combination with LFCN block can affect less quadriceps muscle strength and reduce the use of postoperative analgesics, which is beneficial for the postoperative recovery of AHS patients.

Efficacy of pericapsular nerve group (PENG) block on perioperative pain management in elderly patients undergoing hip surgical procedures: a protocol for a systematic review with meta-analysis and trial sequential analysis

INTRODUCTION

An increasing number of elderly patients suffer from hip diseases associated with moderate to severe perioperative pain during the accelerating global ageing process. Optimal analgesia can decrease perioperative complications and facilitate elderly patients' perioperative recovery. Pericapsular nerve group (PENG) block is a relatively new, analgesia adequate and motor-sparing block technique for perioperative pain management of hip diseases. However, the efficacy of PENG block remains unclear as the limited clinical evidence. Then, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of PENG block for perioperative pain management.

METHODS AND ANALYSIS

PubMed, Ovid Medline, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases will be searched from inception to August 2022 to identify randomised controlled trials of elderly patients accepting PENG block for hip diseases. The primary outcome will be the pain intensity after pain management. Secondary outcomes will be quadriceps strength, perioperative rescue analgesia information and perioperative complications. Assessment of heterogeneity will be primarily inspected by forest plots. If there is no indication of funnel plot asymmetry, a random-effects meta-analysis will be performed. The Cochrane risk-of-bias tool, Grading of Recommendations Assessment, Development and Evaluation and trial sequential analysis will be conducted to evaluate the evidence quality and control the random errors. Funnel plots and Egger's regression test will be performed to evaluate publication bias.

ETHICS AND DISSEMINATION

Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42022313895.

The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center

INTRODUCTION

The novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and safety of a preoperative PENG block among patients undergoing ambulatory hip arthroscopic surgery where systemic analgesia is the gold standard.

METHODS

We conducted a single-center, retrospective pragmatic exploratory cohort study of consecutive outpatient hip arthroscopic surgery cases from January 2017 to March 2019. We identified 164 cases in which patients received general anesthesia with or without a preoperative PENG block. The primary analgesic outcome measures were time to first postoperative analgesic request, intraoperative and postoperative opioid consumption (intravenous morphine equivalent), and postoperative pain severity (visual analog scale 10 cm scale ranging from 0=no pain to 10=severe pain) in hospital. Secondary outcomes included duration of stay in the postanesthesia care unit, opioid-related side effects, time to discharge readiness, and block-related complications.

RESULTS

Seventy-five cases received a preoperative PENG block and 89 cases received systemic analgesia alone. The addition of a PENG block reduced intraoperative (6.6 mg vs 7.5 mg, difference: 0.9 mg; 95% CI 0.2 to 1.7; p=0.01) and postoperative (10.7 mg vs 13.9 mg, difference: 3.2 mg; 95% CI 0.9 to 5.5; p=0.01) intravenous morphine consumption, as well as the mean (3.5 vs 4.2, difference: 0.7; 95% CI 0.1 to 1.3; p=0.03) and highest (5.5 vs 6.5, difference: 1.0; 95% CI 0.2 to 1.7; p=0.02) postoperative pain severity scores in hospital. The PENG block did not prolong the time to first analgesic request (15.8 min vs 12.3 min, difference: 3.5 min; 95% CI -9.0 to 2.0; p=0.23). Fewer patients in the PENG group experienced postoperative nausea and vomiting compared with systemic analgesia alone (36% vs 52%, OR 1.9; 95% CI 1.0 to 3.6; p=0.02), while the PENG block expedited discharge readiness (165.0 min vs 202.8 min, difference: 37.8 min; 95% CI 2.9 to 72.3; p=0.04). No block-related complications were noted in any patient.

DISCUSSION

Based on our retrospective dataset, this pragmatic exploratory cohort study suggests that a preoperative PENG block is associated with questionable improvements in postoperative in-hospital analgesic outcomes which may or may not prove to be clinically relevant when compared with systemic analgesia alone for patients undergoing hip arthroscopic surgery. This small signal should be investigated in a prospective randomized trial.

Comparative efficacy analysis of ultrasound-guided quadratus lumborum block and lumbar plexus block in hip arthroscopy: a pilot prospective randomized controlled trial

Controlled trials assessing quadratus lumborum block (QLB) for post-operative analgesia in hip surgery are scarce. This study aimed to compare ultrasound-guided QLB and lumbar plexus block (LPB) for clinical efficacy in hip arthroscopy. Patients undergoing hip arthroscopy in Beijing Jishuitan Hospital in January–June 2019 were randomized to the lumbar plexus (L) and quadratus lumborum (Q) groups (n = 25/group). After either ultrasound-guided block for 30 min, both groups were prepared for surgery after muscle strength measurement in the affected limbs. Opioid doses for patient-controlled analgesia (PCA), visual analog scale (VAS) scores in the resting and active states, upon leaving the post-anesthesia care unit (PACU), and at 2–48 h post-surgery were recorded, and post-operative complications were also recorded. Muscle strength in the affected limbs was significantly higher in the Q group compared with the L group (4.0 versus 2.0, P &lt; 0.001). VAS scores were similar in both groups post-surgery (P &gt; 0.05). One patient had epidural spread in the L group, with no other complications. Compared with ultrasound-guided LPB, ultrasound-guided QLB provides similar and good post-operative analgesia after hip arthroscopy, with less impact on muscle strength and fewer complications. These results should be confirmed in larger trials.

Fascia Iliaca Pain Block Results in Lower Overall Opioid Usage and Shorter Hospital Stays than Epidural Anesthesia After Hip Reconstruction in Children With Cerebral Palsy

INTRODUCTION AND OBJECTIVE

Epidural anesthesia (EA) is often used for pain control in children with cerebral palsy (CP) who undergo hip reconstructions. The purpose of this study is to determine if preoperative fascia iliaca (FI) pain blocks would improve pain scores, decrease opioid use, and result in shorter hospital stays in comparison to the use of EA.

METHODS

This is a nonrandomized retrospective cohort study examining 60 consecutive patients with CP who underwent hip reconstruction utilizing either a fascia iliac compartment nerve block (FICNB) (N=37) or continuous lumbar epidural (N=22) from January 2017 to March 2019. Age at surgery was 8.5±4.6 years. We recorded age, weight, operating room (OR) time, FLACC (Face, Legs, Activity, Cry, Consolability scale) scores on postoperative days (PODs) 0, 1, 2, and 3, opioid doses, overall opioid (mg) used, and length of stay. We compared pain scores, opioid usage, OR time, and lengths of stay between our 2 patient groups.

RESULTS

Pain scores were similar between groups on POD #0, 2, and 3 but were statistically improved on POD #1 (1.8±1.3 vs. 3.1±1.4, P<0.001). Total number of opiod doses (7.9±4.4 vs. 10.7±2.3, P=0.004), total milligram given (18.3±11.8 vs. 24.7±12.3, P<0.05), and milligram per kilogram given (0.77±0.42 vs. 1.11 mg/kg±0.36 mg/kg, P=0.001) were less for the FI group versus the epidural group. The OR time (which includes time for blocks/epidurals) was lower in the FI group (4.6±1.2 vs. 5.7±1.1 h, P=0.0002). Overall hospital stays were lower in the FI group (3.4±1.5 vs. 4.1±1.0 d, P<0.05).

CONCLUSIONS

This study demonstrates that in the setting of hip reconstruction, patients that received preoperative FI blocks used a lower amount of opioids, required fewer rescue doses and ultimately had a shorter hospital length of stay than those undergoing EA.

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Background:

Despite the rapid growth in the use of hip arthroscopy, standardized data on postoperative pain scores and activity level are lacking.

Purpose:

To quantify narcotic consumption and use of the stationary bicycle in the early postoperative period after hip arthroscopy.

Study Design:

Case series; Level of evidence, 4.

Methods:

In this prospective case series, patients undergoing a primary hip arthroscopy procedure by a single surgeon were asked to fill out a daily survey for 9 days postoperatively. Patients were asked to report their pain level each day on a visual analog scale from 1 to 10, along with the amount of narcotic pain pills they used during those postoperative days (PODs). Narcotic usage was converted to a morphine-equivalent dosage (MED) for each patient. Patients were also instructed to cycle daily starting on the night of surgery for a minimum of 3 minutes twice per day and were asked to rate their pain as a percentage of their preoperative pain level and the number of minutes spent cycling on a stationary bicycle per day.

Results:

A total of 212 patients were enrolled in this study. Pain levels (POD1, 5.5; POD4, 3.8; POD9, 2.9; P < .0001) and the percentage of preoperative pain (POD1, 51.6%; POD4, 31.8%; POD9, 29.5%; P < .01) significantly decreased over the study period. The amount of narcotics used per day (reported in MED) also significantly decreased (POD1, 27.3; POD4, 22.3; POD9, 8.5; P < .0001). By POD4, 41% of patients had discontinued all narcotics, and by POD9, 65% of patients were completely off narcotic medication. Patients were able to significantly increase the number of minutes spent cycling each day (POD1, 7.6 minutes; POD4, 13.8 minutes; POD9, 19.0 minutes; P < .0001). Patients who received a preoperative narcotic prescription for the affected hip were significantly more likely to require an additional postoperative narcotic prescription (P < .001).

Conclusion:

Patients can expect a rapid decrease in narcotic consumption along with a high degree of activity tolerance in the early postoperative period after hip arthroscopy.

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here's Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.

Survey results from an international hip course: comparison between experts and non-experts on hip arthroscopy clinical practice and post-operative rehabilitation

PURPOSE

The purpose of this study was to compare the clinical practices between expert and non-expert arthroscopy hip surgeons.

METHODS

Registered orthopedic surgeons completed anonymous surveys during a hip arthroscopy meeting. The survey included 60 questions on physician's level of expertise, surgical anesthesia, procedures performed, hospital stay, pain control, rehabilitation and socioeconomic parameters, and the results are presented. Comparisons were made between hip arthroscopy experts (> 500 cases performed) and non-experts (≤ 500 cases performed) on aspects of patient care.

RESULTS

Forty-eight (74%) surgeons responded. Forty-four questionnaires were filled out completely. There were no significant differences in recommendations between 15 (34%) hip arthroscopy experts and 29 (66%) non-experts on hip capsular management and cartilage repair techniques, use of antithrombotic prophylaxis and opioid analgesics, time of rehabilitation initiation and patient compliance factors, use of hip brace and CPM, and patient evaluation to return to sports following surgery. Surgical expertise was significantly associated with the performance of hip labral reconstruction (p = 0.016), subspine decompression (p = 0.039) and recommendation of a longer period of restricted weight bearing following the performance of microfractures (p = 0.011). There were no significant differences in clinical practice between surgeons who performed hip arthroscopy exclusively versus those who did not.

CONCLUSIONS

Hip arthroscopy is a relatively new field, and clinical practice may vary among physicians based on the surgical expertise. In this study, hip arthroscopy experts agree with non-experts on most aspects of patient care. Surgical expertise was associated with performance of advanced techniques and recommendation of longer period of restricted weight bearing following performance of microfractures. This study highlights different care patterns that need to be investigated to determine which treatment results in improved patient care.

LEVEL OF EVIDENCE

V.

Implementation of the Obturator Nerve Block into a Supra-Inguinal Fascia Iliaca Compartment Block Based Analgesia Protocol for Hip Arthroscopy: Retrospective Pre-Post Study

Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0–890.0) µg; FO: 482.8 (305.8–635.0) µg; p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8–803.0) µg). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.

Effect of different anaesthetic techniques on gene expression profiles in patients who underwent hip arthroplasty

Objectives

To investigate the modulation of genes whose expression level is indicative of stress and toxicity following exposure to three anaesthesia techniques, general anaesthesia (GA), regional anaesthesia (RA), or integrated anaesthesia (IA).

Methods

Patients scheduled for hip arthroplasty receiving GA, RA and IA were enrolled at Rizzoli Orthopaedic Institute of Bologna, Italy and the expression of genes involved in toxicology were evaluated in peripheral blood mononuclear cells (PBMCs) collected before (T0), immediately after surgery (T1), and on the third day (T2) after surgery in association with biochemical parameters.

Results

All three anaesthesia methods proved safe and reliable in terms of pain relief and patient recovery. Gene ontology analysis revealed that GA and mainly IA were associated with deregulation of DNA repair system and stress-responsive genes, which was observed even after 3-days from anaesthesia. Conversely, RA was not associated with substantial changes in gene expression.

Conclusions

Based on the gene expression analysis, RA technique showed the smallest toxicological effect in hip arthroplasty.

Trial registration

ClinicalTrials.gov number NCT03585647.

Evaluation of a self-retaining distractor for hip joint arthroscopy in toy breed dogs

Background

Hip arthroscopy has become a viable option over the last few years for small animal orthopedic diseases, including hip dysplasia, osteoarthritis, and joint evaluation. However, the narrow joint spaces make it difficult to manipulate the instrument, and depth of tissues make it difficult to distract the joint space. In addition, it is very difficult to maintain consistent distraction over time with a manual distraction due to hand fatigue. To overcome these difficulties, distractors are used in human medicine to improve safety and accuracy of arthroscopy. Therefore, in this study, distractor devices were applied to hip joints in small toy breed dogs to evaluate their technical efficacy. Potential iatrogenic neurovascular and articular damage were also evaluated by comparing two techniques for performing hip joint arthroscopy: the self-retaining distractor and external manipulation.

Results

The mean ± SD of the joint distraction distance was 8.88 ± 3.54 mm in the self-retaining distraction group and 2.37 ± 0.82 mm in the manual traction group. As the joint space increased, surgeons could more easily place an arthroscopy portal and more comfortably manipulate the instrument with a distractor device. Furthermore, the acetabular cartilage damage (p = 0.004) was significantly greater in the external manipulation group, but articular damage to the femoral head (p = 0.940) was similar in both groups.

Conclusion

The results of this study revealed that use of a distractor device can be a viable option for performing hip arthroscopy in small animals. The device significantly improved the surgeon’s performance without surgical assistance, and it reduced iatrogenic cartilage damage compared with manual traction. Further study is needed to quantify neurapraxia associated with distractor placement.

Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies

BACKGROUND

Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications.

PURPOSE

To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy.

STUDY DESIGN

Systematic review.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature for postoperative pain control after hip arthroscopy was performed using electronic databases. Only comparative clinical studies with level 1 to 3 evidence comparing a method of postoperative pain control with other modalities or placebo were included in this review. Case series and studies without a comparative cohort were excluded.

RESULTS

Several methods of pain management have been described for hip arthroscopy. A total of 14 studies met our inclusion criteria: 3 on femoral nerve block, 3 on lumbar plexus block, 3 on fascia iliaca block, 4 on intra-articular injections, 2 on soft tissue surrounding surgical site injection, and 2 on celecoxib (4 studies compared 2 or more methods of analgesia). The heterogeneity of the studies did not allow for pooling of data. Single-injection femoral nerve blocks and lumbar plexus blocks provided improved analgesia, but increased fall rates were observed. Fascia iliaca blocks do not provide adequate pain relief when compared with surgical site infiltration with local anesthetic and are associated with increased risk of cutaneous nerve deficits. Patients receiving lumbar plexus block experienced significantly decreased pain compared with fascia iliaca block. Portal site and periacetabular injections provide superior analgesia compared with intra-articular injections alone. Preoperative oral celecoxib, compared with placebo, resulted in earlier time to discharge and provided significant pain relief up to 24 hours.

CONCLUSION

Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. Intra-articular and portal site injections with local anesthetics and preoperative celecoxib can decrease opioid consumption. There is a lack of high-quality evidence on this topic, and further research is needed to determine the best approach to manage postoperative pain and optimize patient satisfaction.

Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Ambulatory hip arthroscopy is associated with postoperative pain routinely requiring opioid analgesia. The potential role of peripheral nerve blocks for pain control after hip arthroscopy is controversial. This trial investigated whether a preoperative fascia iliaca block improves postoperative analgesia.

Methods

In a prospective, double-blinded trial, 80 patients scheduled for hip arthroscopy were randomized to receive a preoperative fascia iliaca block with 40 ml ropivacaine 0.2% or saline. Patients also received an intraarticular injection of 10-ml ropivacaine 0.2% at procedure end. Primary study endpoint was highest pain score reported in the recovery room; other study endpoints were pain scores and opioid use 24 h after surgery. Additionally, quadriceps strength was measured to identify leg weakness.

Results

The analysis included 78 patients. Highest pain scores in the recovery room were similar in the block group (6 ± 2) versus placebo group (7 ± 2), difference: −0.2 (95% CI, −1.1 to 0.7), as was opioid use (intravenous morphine equivalent dose: 15 ± 7mg [block] vs. 16 ± 9 mg [placebo]). Once discharged home, patients experienced similar pain and opioid use (13 ± 7 mg [block] vs. 12 ± 8 mg [placebo]) in the 24 h after surgery. The fascia iliaca block resulted in noticeable quadriceps weakness. There were four postoperative falls in the block group versus one fall in the placebo group.

Conclusions

Preoperative fascia iliaca blockade in addition to intraarticular local anesthetic injection did not improve pain control after hip arthroscopy but did result in quadriceps weakness, which may contribute to an increased fall risk. Routine use of this block cannot be recommended in this patient population.

Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications

PURPOSE

The purpose of this article is to (1) examine trends in preoperative and prolonged postoperative opioid analgesic use in patient undergoing hip arthroscopy, (2) characterize risk factors for prolonged opioid analgesic use following hip arthroscopy, and (3) explore preoperative and prolonged postoperative opioid analgesic use as independent risk factors for complications following hip arthroscopy.

METHODS

A private insurance database was queried for patients undergoing hip arthroscopy from 2007 to 2015 with a minimum of 6 months of follow-up. Independent risk factors for prolonged opioid analgesic use were determined. Preoperative and prolonged opioid analgesic use as risk factors for complications were examined.

RESULTS

There was a significantly decreasing trend in preoperative (P = .002) and prolonged postoperative (P = .009) opioid analgesic use. The most significant risk factor for prolonged postoperative opioid analgesic use was preoperative use (odds ratio [OR], 3.61; P < .0001). Other preoperative prescriptions, including muscle relaxants (OR, 1.5; P < .0001) and anxiolytics (OR, 2.0; P < .0001), were also significant risk factors. Preoperative opioid analgesic use was a significant risk factor for postoperative complications, including emergency room visits (OR, 2.1; P < .0001) and conversion to total hip arthroplasty (THA) (OR, 1.6; P < .0001). Prolonged postoperative opioid analgesic use was associated with a higher risk of revision hip arthroscopy (OR, 1.4; P = .0004) and conversion to THA (OR, 1.8; P < .0001).

CONCLUSIONS

More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged opioid analgesic use is preoperative opioid analgesic use. Additionally, anxiolytics, substance use or abuse, morbid obesity, and back pain were among the more notable risk factors for prolonged postoperative opioid analgesic use. Preoperative and prolonged postoperative opioid analgesic use was associated with a higher likelihood of several adverse effects/complications.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Prospective, Observational Study of Opioid Use After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To provide estimates of postoperative opioid use after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify risk factors for increased postoperative opioid use.

METHODS

All patients aged at least 18 years who were undergoing hip arthroscopy for FAI syndrome performed by 1 of 2 hip-preservation surgeons between November 2015 and August 2016 were eligible for inclusion in this study. Target minimum enrollment was set at 30 patients per surgeon based on an a priori sample size calculation. Enrolled patients completed the International Hip Outcome Tool, visual analog pain scale, Pain Catastrophizing Scale, abbreviated Patient Health Questionnaire, and questions regarding demographic characteristics and opioid and anti-inflammatory use. Opioid consumption was assessed through pill counting at 2- and 6-week postoperative appointments. Of 80 patients enrolled, 67 had complete 2- and 6-week opioid use data. Patient and operative factors were correlated with outcomes in multivariate models.

RESULTS

Opioid use in the 2 weeks before surgery was significantly associated with higher postoperative opioid use at 2 weeks postoperatively (253.8 additional oral morphine equivalents [OMEs]; 95% confidence interval [CI], 171.2-336.5 additional OMEs; P < .0001; n = 73) and 6 weeks postoperatively (385.3 additional OMEs; 95% CI, 241.6-529.0 additional OMEs; P < .0001; n = 67). By 6 weeks postoperatively, 41 of 52 patients (79%) without opioid use in the 2 weeks before surgery used 30 or fewer 5-mg oxycodone pills compared with only 2 of 15 patients (13%) with preoperative use (odds ratio, 24.9; 95% CI, 4.2-148.5; P < .0001).

CONCLUSIONS

Among patients undergoing hip arthroscopy for FAI syndrome, any opioid use in the 2 weeks preceding surgery was the strongest predictor of opioid use after hip arthroscopy. The impact of preoperative opioid use far exceeded the impact of other baseline patient and operative factors. Assessment of preoperative opioid use could be an important factor in guiding postoperative opioid prescribing.

LEVEL OF EVIDENCE

Level II, prospective observational study.