Lichtenstein Adi, Amar Eyal, Halperin Dania, Factor Shai, Ohana Nissim, Albagli Assaf, Efrima Ben, Rath Ehud
Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Hip Preserv Surg. 2023 Apr 27;10(2):119-122. doi: 10.1093/jhps/hnad011. eCollection 2023 Jul.
Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4-6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0-6, standard error - 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.
适当的术后疼痛控制已被证明可缩短住院时间并促进日间手术。髋臼周围注射布比卡因对髋关节镜检查后的疼痛缓解有效。本研究旨在评估髂前上棘（ASIS）作为一个解剖标志，以利于在荧光透视前插入针头。从ASIS远端一个手指宽度处的垂直线与大转子（GT）的纵线的交汇点被用作30例连续髋关节镜检查患者进行髋臼周围镇痛的标志。通过荧光透视测量针头尖端与髋臼顶之间的距离。如有需要，校正针头位置，然后进行髋臼周围布比卡因注射（在关节的前、外侧和后侧）。术后4 - 6小时及出院时使用视觉模拟量表（VAS）测量疼痛。在所有病例中均识别出ASIS和GT并将其用作髋臼周围镇痛标志。结果显示，93.3%的针头插入点落在髋臼外侧缘10毫米范围内，只有1例落在其远端。术后平均VAS评分为1.03（范围0 - 6，标准误 - 0.30，中位数 = 0）。出院时，90%（30例患者中的27例）报告VAS评分≤5。30例患者中有26例在手术当天出院（其余4例患者因住宿/出行问题留院）。ASIS和GT可作为髋关节镜检查中髋臼周围镇痛的解剖标志，针头定位可重复，镇痛效果显著且辐射最小。
