A Retrospective Study of Anesthetic Considerations in Hip Arthroscopy

Hip arthroscopy is a surgical procedure that allows doctors to view the hip joint without making a large incision (cut) through the skin and other soft tissues. This surgery is notable for significant improvement in patient reported outcomes, with high patient satisfaction. However, despite the minimally invasive nature of arthroscopy, patients may experience notable pain post-procedure. 

In this paper, a retrospective analysis was performed for 92 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) with labral tear under general anesthesia (G) with fascia-iliaca block (64 patients) or regional anesthesia (R) with fascia-iliaca block (28 patients) from March 9, 2016 to April 9, 2018. Data collected included: demographics, diagnosis, ASA status, time in surgery, medications administered, type of anesthesia administered, pain scores, use of straight catheter, and time in Post Anesthesia Care Unit (PACU). 

The results showed that patients who underwent hip arthroscopy under regional anesthesia reported significantly less first (G: 3.4 (3.9), R: 1.3 (3.0), p = 0.0085) and average (G: 3.8 (2.5), R: 2.0 (2.2), p = 0.0038) pain post-operatively. Patients under regional anesthesia also received less total morphine milligram equivalents (MME) intraoperatively and post-operatively (G: 40.8 (21.7) MME, R: 24.9 (17.8), p = 0.004 MME). Patients under regional anesthesia had a significantly higher incidence of urinary retention (G: 3.1%, R: 28.6%, p = 0.009) and increased time spent in PACU (G = 181.9 (86.3), R: 251.4 (80.4), p = 0.0001). 

In conclusion, for hip arthroscopy, administration of a regional anesthetic combined with multimodal analgesics and a peripheral nerve block significantly reduced postoperative pain scores in PACU and reduced the perioperative use of opioids compared to general anesthesia combined with multimodal analgesics and a peripheral nerve block. However, this technique may result in urinary retention and a longer recovery time in PACU. Further clinical studies are needed to clearly verify the superior efficacy of pain management with a lower side-effect profile in comparison to general anesthesia.

Article by Molly Kraus, et al, from USA.

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