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Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine whether different regimens of multimodal analgesia will reduce postoperative pain scores, opioid consumption, costs and hospital length-of-stay following hip arthroscopy.

Methods

From 2018 to 2021, 132 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were included in this prospective, single-center randomized controlled trial. Patients were randomized into four treatment groups:

  1. (1)

    Group 1—Control: opioid medication (oxycodone-acetaminophen 5 mg/325 mg, 1–2 tabs q6H as needed), Heterotopic ossification prophylaxis—Naprosyn 500 mg twice daily × 3 weeks);

  2. (2)

    Group 2—Control + postoperative sleeping aid (Zopiclone 7.5 mg nightly × 7 days);

  3. (3)

    Group 3—Control + preoperative and postoperative Gabapentin (600 mg orally, 1 h preoperatively; 600 mg postoperatively, 8 h following pre-op dose);

  4. (4)

    Group 4—Control + pre-medicate with Celecoxib (400 mg orally, 1 h preoperatively)

The primary outcome was pain measured with a visual analog scale, monitored daily for the first week and every other day for 6 weeks. Secondary outcomes included opioid consumption, healthcare resource use, and hospital length of stay.

Results

Patient characteristics were similar between groups. There were no statistically significant differences in pain scores between groups at any timepoint after adjusting for intra-operative traction time, intra-operative opioid administration and preoperative pain scores (p > 0.05). There were also no significant differences in the number of days that opioids were taken (n.s.) and the average daily morphine milligram equivalents consumed (n.s.). Similarly, there were no statistically significant differences in length of stay in the experimental groups, compared with the control group (n.s.). Finally, there were no differences in cost between groups (n.s.).

Conclusion

The routine use of Zopiclone, Celecoxib and Gabapentin did not improve postoperative pain control or reduce length-of-stay following hip arthroscopy. Therefore, these medications are not recommended for routine postoperative pain control following hip arthroscopy.

Level of evidence

l.

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Data availability

The data of this study are available from the corresponding author upon request.

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Funding

The authors would like to acknowledge the Lawson Health Research Institute for their support of this research through an Internal Research Fund (#F06-19).

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Authors and Affiliations

  1. Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada

    Ryan M. Degen, Andrew Firth, Herman Sehmbi, Ashley Martindale, Stacey Wanlin, Kevin Willits & Dianne Bryant

  2. Bone and Joint Institute, Western University, London, ON, Canada

    Ryan M. Degen, Kevin Willits & Dianne Bryant

  3. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Ryan M. Degen, Kevin Willits & Dianne Bryant

  4. Department of Anesthesia, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Herman Sehmbi

  5. Faculty of Health Sciences, Western University, London, Canada

    Clara Chen, Jacqueline D. Marsh & Dianne Bryant

  6. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

    Dianne Bryant

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  1. Ryan M. Degen
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Corresponding author

Correspondence to Ryan M. Degen.

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Ethical approval

This study was registered with http://www.clinicaltrials.gov (NCT03351439) and approved by our institutional review board (Western University Health Sciences REB ID# 110350).

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Degen, R.M., Firth, A., Sehmbi, H. et al. Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 31, 4016–4026 (2023). https://doi.org/10.1007/s00167-023-07445-5

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  • DOI: https://doi.org/10.1007/s00167-023-07445-5

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