Institutional members access full text with Ovid®

Share this article on:

Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents

Novais, Eduardo, N., MD*; Kestel, Lauryn, BS; Carry, Patrick, M., BA; Sink, Ernest, MD; Strupp, Kim, MD§

Journal of Pediatric Orthopaedics: January 2018 - Volume 38 - Issue 1 - p 9–15
doi: 10.1097/BPO.0000000000000725
Hip

Background: Open treatment of femoroacetabular impingement (FAI) through a surgical hip dislocation (SHD) approach has been reported to allow for improvement in pain and function. However, the approach require a trochanteric osteotomy and may be associated with high level of pain after surgery. Currently, there is no systematic approach for pain management after SHD for treatment of FAI.

Methods: A retrospective chart review was used to collect data from 121 subjects (12 to 21 y and below) who received periarticular local infiltration analgesia (LIA, n=20), epidural analgesia (n=72), or intravenous patient-controlled analgesia (PCA, n=29) after SHD from January 2003 to June 2014. Verbal pain scores, opioid consumption, incidence of side effects/complications, and length of hospital stay (LOS) were recorded. All nonopioid medications with analgesic potential were included in the statistical models as potential confounding variables

Results: Twelve hours after surgery, the odds of moderate/severe pain were higher in the PCA group (odds ratio, 20.5; 95% confidence interval (CI), 1.7-243.8; P=0.0166] and epidural group (odds ratio, 5.2; 95% CI, 0.7-92.0; P=0.3218) compared with the LIA group. There was no difference in pain scores across all groups 1 hour (P=0.0675) or 24 hours (P=0.3473) postoperatively. Total opioid consumption in the LIA group was 59.8% (95% CI, 15.0%-81.0%; P=0.0175) lower than the total opioid consumption in the epidural group and 60.7% (95% CI, 17.3-81.3; P=0.0144) lower than the total opioid consumption in the PCA group. LOS was increased in the epidural (mean difference, 22.1; 95% CI, 6.8-37.4 h; P=0.0051) and PCA (mean difference, 16 h; 95% CI, 1-31.5 h; P=0.0367) groups relative to the LIA group. There was 0 (0%) complication in the LIA group compared with 11 (15.3%) in the epidural group.

Conclusions: LIA was more effective at controlling pain 12 hours after surgery in comparison with PCA with similar pain control to epidural. LIA was associated with significantly lower need for opioids and shorter LOS compared with the PCA and epidural protocols. Periarticular infiltration should be considered for pain management after SHD for treatment of FAI in adolescents.

Level of Evidence: Level III—retrospective comparative study.

Departments of *Orthopaedic Surgery

Orthopaedic Surgery, Musculoskeletal Research Center

§Anesthesiology, Children’s Hospital Colorado, Aurora, CO

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY

Supported in part by NIH/NCRR Colorado CTSI Grant Number UL1 RR025780. Contents are the authors’ sole responsibility and do not represent official NIH views.

The authors declare no conflicts of interest.

Reprints: Eduardo N. Novais, MD, Department of Orthopaedic Surgery, Children’s Hospital Colorado, 13123 East 17th Avenue, B600, Aurora, CO 80045. E-mail: eduardo.novais@childrenscolorado.org.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.