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Surgical predictors of acute postoperative pain after hip arthroscopy.

Tan CO, Chong YM, Tran P, Weinberg L, Howard W - BMC Anesthesiol (2015)

Bottom Line: Little published data exists demonstrating reliable predictors of significant pain after hip arthroscopy.Other significant factors included hip arthroscopy that involved femoral chondro-ostectomy (OR 5.8) and labral repair (OR 7.5).Identification of these predictors in individual patients may guide clinical practice regarding the choice of more invasive regional analgesia options.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Austin Hospital, 145 Studley Rd, Heidelberg, VIC, 3084, Australia. Drchongtan@gmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Linear regression of total intraoperative arthroscopic fluid volumes versus intraoperative & recovery room morphine requirements
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Fig3: Linear regression of total intraoperative arthroscopic fluid volumes versus intraoperative & recovery room morphine requirements

Mentions: Patients who underwent arthroscopy with 80 mm Hg infusion pressure received arthroscopic fluid volumes at a rate of 300 ml/min (95 % CI 290–310 ml/min) into the hip joint and surrounding tissues compared with 210 ml/min for those whose infusion pressure was 40 mm Hg (200–220 ml/min, R2 > 0.9, p < 0.0001). However, there was only minor correlation between total volumes infused and the pain severity outcomes of NRS scores and IV morphine requirements (largest Pearson’s R <0.36, Table 2, Figs. 2,3). Statistical significance was achieved for these dependent variables, however the prediction bands around the regression lines were broad (Table 2).Table 2


Surgical predictors of acute postoperative pain after hip arthroscopy.

Tan CO, Chong YM, Tran P, Weinberg L, Howard W - BMC Anesthesiol (2015)

Linear regression of total intraoperative arthroscopic fluid volumes versus intraoperative & recovery room morphine requirements
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489023&req=5

Fig3: Linear regression of total intraoperative arthroscopic fluid volumes versus intraoperative & recovery room morphine requirements
Mentions: Patients who underwent arthroscopy with 80 mm Hg infusion pressure received arthroscopic fluid volumes at a rate of 300 ml/min (95 % CI 290–310 ml/min) into the hip joint and surrounding tissues compared with 210 ml/min for those whose infusion pressure was 40 mm Hg (200–220 ml/min, R2 > 0.9, p < 0.0001). However, there was only minor correlation between total volumes infused and the pain severity outcomes of NRS scores and IV morphine requirements (largest Pearson’s R <0.36, Table 2, Figs. 2,3). Statistical significance was achieved for these dependent variables, however the prediction bands around the regression lines were broad (Table 2).Table 2

Bottom Line: Little published data exists demonstrating reliable predictors of significant pain after hip arthroscopy.Other significant factors included hip arthroscopy that involved femoral chondro-ostectomy (OR 5.8) and labral repair (OR 7.5).Identification of these predictors in individual patients may guide clinical practice regarding the choice of more invasive regional analgesia options.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Austin Hospital, 145 Studley Rd, Heidelberg, VIC, 3084, Australia. Drchongtan@gmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus