Philippi Matthew T, Kahn Timothy L, Adeyemi Temitope F, Maak Travis G, Aoki Stephen K
University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, USA.
Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA.
J Hip Preserv Surg. 2018 Sep 18;5(3):226-232. doi: 10.1093/jhps/hny030. eCollection 2018 Aug.
Hip arthroscopy patients can experience significant post-operative pain. Many strategies to combat this pain have been explored including nerve blocks, which can be costly. An alternative option for pain management is local infiltration analgesia (LIA) which has been studied in hip and knee arthroplasty, but its ability to decrease pain in the setting of hip arthroscopy remains uncertain. A prospective randomized controlled trial of 74 patients who underwent hip arthroscopy at a single medical center was performed. Thirty-seven patients received a 20-ml extracapsular injection of 0.25% bupivacaine-epinephrine under direct arthroscopic visualization after capsular closure while 37 from the control group received no injection. Primary outcome measures were both maximum and discharge numeric rating scale (NRS) pain scores while in the post-anesthesia care unit (PACU). The LIA group had a statistically significant decrease in the maximum PACU NRS score (6.16 versus 7.35, = 0.009), however this did not reach the level of minimal clinically important difference of 1.5. There was an insignificant difference in discharge PACU pain scores. This is the first randomized controlled trial studying extracapsular LIA in hip arthroscopy. While LIA offers an uncomplicated and low-cost approach to post-operative pain management, this specific technique did not reduce pain to a clinically significant level.
髋关节镜手术患者术后可能会经历严重疼痛。人们已经探索了许多对抗这种疼痛的策略，包括神经阻滞，但这可能成本高昂。疼痛管理的另一种选择是局部浸润镇痛（LIA），它已在髋关节和膝关节置换术中进行了研究，但其在髋关节镜手术中减轻疼痛的能力仍不确定。在一家医疗中心对74例行髋关节镜手术的患者进行了一项前瞻性随机对照试验。37例患者在关节囊闭合后在直接关节镜观察下接受了20毫升0.25%布比卡因-肾上腺素的关节囊外注射，而对照组的37例患者未接受注射。主要结局指标是在麻醉后护理单元（PACU）时的最大和出院数字评定量表（NRS）疼痛评分。LIA组在PACU的最大NRS评分有统计学显著下降（6.16对7.35，P = 0.009），然而这未达到最小临床重要差异1.5的水平。出院时PACU疼痛评分无显著差异。这是第一项研究髋关节镜手术中关节囊外LIA的随机对照试验。虽然LIA为术后疼痛管理提供了一种简单且低成本的方法，但这种特定技术并未将疼痛减轻到临床显著水平。
