title: Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine.
abstract: OBJECTIVE
  To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy.
  
  
  METHODS
  Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% injection, and the second group received preemptive periacetabular 20 mL of bupivacaine 0.5% injection. Before closure all patients received an additional dose of 20 mL of bupivacaine 0.5% intra-articularly. Data were compared with respect to postoperative pain with visual analog scale (VAS) and analgesic consumption, documented in a pain diary for 2 weeks after surgery.
  
  
  RESULTS
  Twenty-one patients were treated with intra-articular injection, and 21 patients with peri-acetabular injection. There were no significant differences with regards to patient demographics or surgical procedures. VAS scores recorded during the first 30 minutes postoperatively and 18 hours after surgery were significantly lower in the periacetabular group compared with in the intra-articular group (0.667 ± 1.49 vs 2.11 ± 2.29; P < .045 and 2.62 ± 2.2 vs 4.79 ± 2.6; P < .009). There were no differences between the groups with regard to analgesic consumption.
  
  
  CONCLUSIONS
  Periacetabular injection of bupivacaine 0.5% was superior to intra-articular injection in pain reduction after hip arthroscopy at 30 minutes and 18 hours postoperatively. However, total analgesic consumption over the first 2 postoperative weeks and VAS pain measurements were not significantly affected.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Shlaifer
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel. Electronic address: zachsharfman@gmail.com.
authors.forename: Zachary Tuvya
authors.initials: ZT
authors.lastname: Sharfman
authors.affiliation: Hip Preservation Center, Baylor University Medical Center, Dallas, Texas, U.S.A.
authors.forename: Hal David
authors.initials: HD
authors.lastname: Martin
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Amar
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Efi
authors.initials: E
authors.lastname: Kazum
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Warschawski
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Matan
authors.initials: M
authors.lastname: Paret
authors.affiliation: Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Silviu
authors.initials: S
authors.lastname: Brill
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.affiliation: Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Rath
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D002045:Bupivacaine / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D010098:Oxycodone / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; C514822:oxycodone-acetaminophen; D000082:Acetaminophen; D010098:Oxycodone; D002045:Bupivacaine