Surgical predictors of acute postoperative pain after hip arthroscopy
Tan et al. BMC Anesthesiology
Surgical predictors of acute postoperative pain after hip arthroscopy
Chong Oon Tan 0 1
Yew Ming Chong 2
Phong Tran 3
Laurence Weinberg 0 1
William Howard 0 1
0 The University of Melbourne , Melbourne, VIC 3010 , Australia
1 Department of Anaesthesia, The Austin Hospital , 145 Studley Rd, Heidelberg, VIC 3084 , Australia
2 Department of Surgery, St. Vincent's Hospital Melbourne , Victoria Pde, Fitzroy, VIC , Australia
3 Department of Orthopaedics , Western Health, Gordon St, Footscray, VIC 3011 , Australia
Background: Pain following hip arthroscopy is highly variable and can be severe. Little published data exists demonstrating reliable predictors of significant pain after hip arthroscopy. The aim of this study was to identify influence of intraoperative factors (arthroscopic fluid infusion pressure, operative type) on the severity of postoperative pain. Methods: A retrospective review of 131 patients who had received a variety of arthroscopic hip interventions was performed. A standardized anaesthetic technique was used on all patients and postoperative pain was analysed using recovery pain severity outcomes and analgesic use. A multivariate logistic regression analysis was performed on intraoperative factors including patient age, sex and BMI, arthroscopic infusion pressures (40 vs 80 mm Hg), amount of fluid used, length of surgery and types of arthroscopic interventions performed. Thirty six patients were also prospectively examined to determine arthroscopic fluid infusion rates for 40 and 80 mm Hg infusion pressures. Results: Use of a higher infusion pressure of 80 mm Hg was strongly associated with all pain severity endpoints (OR 2.8 - 8.2). Other significant factors included hip arthroscopy that involved femoral chondro-ostectomy (OR 5.8) and labral repair (OR 7.5). Length of surgery and total amount of infusion fluid used were not associated with increased pain. Conclusions: 80 mm Hg arthroscopic infusion pressures, femoral chondro-osteoectomy and labral repair are strongly associated with significant postoperative pain, whereas intraoperative infusion volumes or surgical duration are not. Identification of these predictors in individual patients may guide clinical practice regarding the choice of more invasive regional analgesia options. The use of 40 mm Hg arthroscopic infusion pressures will assist in reducing postoperative pain.
Hip arthroscopy; Postoperative pain; Morphine; Numerical rating scale; Regional anaesthesia; Arthroscopic fluid infusion pressure; Labral repair; Femoral chondro-osteoectomy
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Background
Pain following hip arthroscopy is highly variable and in
some cases can be severe, with high patient Numerical
Rating Scale (NRS) pain scores up to 8/10 and associated
high postoperative opioid requirements [1]. An analgesic
management approach based on systemic analgesia alone
is limited by opioid side effects, some of which are more
frequent in the predominantly younger patient population
receiving this procedure. Other analgesic techniques that
may be used include regional analgesia, neuraxial local
analgesia, and intrathecal opioids, but carry with them their
own potentially serious side effects [2?5]. Although
psychological distress is known to influence postoperative
pain in this context [6], there is currently no other data in
the literature identifying surgical risk factors of severe
postoperative pain in hip arthroscopy. We hypothesized
that use of a lower arthroscopic infusion pressure (40 mm
Hg) would minimise periarticular soft tissue swelling, and
hence reduce acute postoperative pain. We also
hypothesized that clinical and intraoperative factors such as
patient demographics, total arthroscopic fluid volumes
infused and the particular surgical interventions
performed were related to the degree of patient?s
postoperative pain. Identification of reliable predictors of severe
postoperative pain would allow directed use of more
invasive analgesia options, justifying the rare but
potentially serious risks of such interventions.
Methods
We performed a retrospective study (Austin Health
Office for Research, Human Research & Ethics Committee
Approval # LNR/14/Austin/2) of 140 consecutive patients
in 2013 who had undergone therapeutic hip arthroscopy
by a single surgeon and anaesthetist with combined
subspecialty experience in the procedure of more than 8 years.
From May 2013, the treating surgeon changed the routine
arthroscopic infusion pressures used from 80 mm Hg to
40 mm Hg for all hip arthroscopies. Arthroscopic infusion
pressures were kept the same throughout the entirety of
each patient?s procedure. Inclusion criteria were all
patients undergoing hip arthroscopy who had received the
same standardised anaesthetic and postoperative pain
regime. Patients who had contraindications to any
component of the standard anaesthetic technique such as
medication allergy or opioid tolerance were excluded from the
study.
All patients were ASA (American So (...truncated)