Surgical predictors of acute postoperative pain after hip arthroscopy

BMC Anesthesiology, Jul 2015

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.

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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 - 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)


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Chong Tan, Yew Chong, Phong Tran, Laurence Weinberg, William Howard. Surgical predictors of acute postoperative pain after hip arthroscopy, BMC Anesthesiology, 2015, pp. 96, 15, DOI: 10.1186/s12871-015-0077-x