Newly Published
Pain Medicine  |   July 2018
Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial
Author Notes
  • From the Departments of Anesthesia and Perioperative Care (M.B., E.N.Y., K.K., S.K., M.W.H., P.A.) and Orthopedic Surgery (A.L.Z.), University of California at San Francisco, San Francisco, California.
  • Submitted for publication October 9, 2017. Accepted for publication May 11, 2018.
    Submitted for publication October 9, 2017. Accepted for publication May 11, 2018.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • The findings of this study were previously presented at the 2017 Annual Meeting of the American Society of Regional Anesthesia on April 7, 2017, in San Francisco, California.
    The findings of this study were previously presented at the 2017 Annual Meeting of the American Society of Regional Anesthesia on April 7, 2017, in San Francisco, California.×
  • Research Support: Support for this study was provided solely from departmental sources.
    Research Support: Support for this study was provided solely from departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: matthias.behrends@ucsf.edu. Raw data available at: matthias.behrends@ucsf.edu.
    Reproducible Science: Full protocol available at: matthias.behrends@ucsf.edu. Raw data available at: matthias.behrends@ucsf.edu.×
  • Correspondence: Address correspondence to Dr. Behrends: Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, California 94143-0648. matthias.behrends@ucsf.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Pain Medicine / Regional Anesthesia
Pain Medicine   |   July 2018
Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial
Anesthesiology Newly Published on July 2, 2018. doi:10.1097/ALN.0000000000002321
Anesthesiology Newly Published on July 2, 2018. doi:10.1097/ALN.0000000000002321
Abstract

What We Already Know about This Topic:

  • Hip arthroscopy is a surgical procedure growing in popularity

  • The optimal approach to postoperative analgesia has not been identified

What This Article Tells Us That Is New:

  • The addition of preoperative fascia iliaca block using ropivacaine to the intraarticular injection of ropivacaine did not improve early postoperative pain scores

  • The fascia iliaca blocks also did not improve most secondary endpoints, although they did cause quadriceps weakness

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.