Thank you. No authors have any relevant disclosures. So as we all know, hip arthroscopy is a very commonly performed procedure, but pain control can be difficult. The vast majority of patients are discharged from the PACU, but we, in today's healthcare, we continuously strive to provide the best pain control to achieve the best outcome and patient satisfaction. At this point, no placebo-controlled, randomized-controlled trials of a preoperative fascia iliaca compartment blockade has been done. So we sought to evaluate this with an ultrasound-guided technique in addition to standardized general anesthetic for hip arthroscopy for patients that are undergoing unilateral primary hip arthroscopy for FAI. We hypothesized that this would lead to improved pain scores and reduce narcotic consumption both in the PACU and in the short-term recovery period, which we defined as six weeks after surgery. We performed an a priori power analysis and concluded that 74 patients would be required to achieve power with the end point being a change of one numeric pain rating scale. So we recruited 74 patients, again, all of which were going unilateral hip arthroscopy for FAI. They were prospectively enrolled and randomized into control and fascia iliaca compartment blockade groups. The control was a normal saline injection. We included patients that were between the ages of 18 and 50 who had an ASA score of 1 or 2 and a tonus grade of 0 or 1. We excluded patients with a history of neuropathic or chronic pain, CRPS, fibromyalgia, or preoperative narcotic use. And I apologize also any patient that was using psychotropic medications. All patients were assessed preoperatively with a modified Harris-Hipps score. As far as the technique goes, the fascia iliaca compartment block group received a preop ultrasound-guided single injection of 30 milliliters of quarter-percent ropy with 1 to 200,000 epinephrine by a board-certified anesthesiologist that had done this block at least 50 times in clinical practice. The control group received this as well, but with normal saline instead of the active block. All patients were given standardized postoperative prescriptions, which included 65 milligram oxycodone tablets, 12 MS-Contin tablets, and HO prophylaxis. As far as the technique goes, without dwelling on this too long, an ultrasound probe is used to identify the femoral neurovascular bundle just lateral to this after penetrating the fascia iliaca. A volume of ropy with epinephrine is injected. During the withdrawal of the needle, the lateral femoral cutaneous nerve is also infiltrated locally. As far as the coverage of this block, typically the capsule of the hip as well as the knee, the anterior lateral thigh, the anterior thigh, and then variably a portion of the saphenous nerve distally by the ankle and leg. Our endpoints for narcotic use interrupt in the PACU and then out to six weeks postoperatively. We looked at pain with a numeric pain rating scale both in the PACU and then on a daily basis with average and maximum pain scores out to six weeks, PACU duration of stay, and then we also assessed neuropathic pain using a patient-reported outcome measure known as the S-LANCE. We found that operative time between groups were similar. They underwent a similar range of procedures for femoral acetabular impingement. We saw the PACU length of stay was significantly reduced in the fasciae liaca compartment blockade group. We also saw a decrease in intraop narcotics for the study group, but this was not statistically significant. A larger difference was noted in the PACU, which was significant. Looking at postop narcotics, these are all demonstrated in morphine equivalent doses. We noted a very significant difference between the study group and the control group. The last day of narcotic use was about three days difference between the study group and the control group. This was not statistically significant, I believe, because of the wide range of days the patients discontinued their narcotics. There was nearly a one-point difference in numeric pain rating scale, which is not very significant as compared to our other endpoints. We also saw a larger decrease in pain in the immediate postop period between postop day one and three. In conclusion, a preop FI block for routine hip scopes resulted in decreased narcotic use, improved pain scores, and an earlier PACU discharge. Thank you.

preoperative fascia iliaca compartment blockade

ultrasound guidance

pain control

hip arthroscopy

femoroacetabular impingement