The Efficacy of Pericapsular Nerve Group Block Versus Facia Iliaca Block on Immediate Postoperative Pain and Opioid Consumption After Hip Arthroscopy Randomized Trial.

BACKGROUND: Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is associated with increased patient satisfaction, earlier mobilization, and decreased opioid consumption. OBJECTIVES: Therefore, there is a need for safe, reliable, and opioid- and motor-sparing methods of achieving postoperative analgesia following hip arthroscopy. We evaluated the efficacy of pericapsular nerve group (PENG) block vs fascia iliaca block (FIB) in reducing postoperative pain and analgesic consumption in the first 24 hours following hip arthroscopy. STUDY DESIGN: A prospective randomized double-blinded control clinical trial. SETTING: At the arthroscopy unit of the orthopedic department of Assiut University Hospitals, Assiut, Egypt from 2019 to 2022. METHODS: Forty-three patients comprising 18 women and 25 men scheduled for hip arthroscopy were randomized to receive a preoperative block with PENG or FIB from March 2019 to March 2022. The mean age was 27.9 years (standard deviation [SD], 6.2 years; range, 18-42 years) and the mean body mass index was 25.13 kg/m2 (SD, 5.08 kg/m2). Patients were randomized into 2 groups: group A comprising 20 patients that received FIB; and group B comprising 23 patients that received PENG block. The efficacies of FIB and PENG block were evaluated using Visual Analog Scale scores. RESULTS: Statistically significant differences in median pain scores and mean at rest pain scores were observed between the 2 groups at all measured time points following surgery (i.e., 6, 12, 18, and 24 hours). Further, dynamic pain scores (with hip flexion) scores significantly differed between the 2 groups at 24 hours postoperatively (P = 0.001). PENG block significantly decreased postoperative opioid use compared to FIB. Total opioid use in the 24-hour postoperative period was lower in the PENG group compared to the FIB group (16.5 ± 9.9 vs 27.5 ± 9.6; P < 005). LIMITATIONS: Different hip pathologies and different interventions lead to different outcomes. Also, a larger sample size and longer follow-up duration are required. CONCLUSIONS: PENG block may represent the ideal regional anesthesia modality for hip arthroscopy as an alternative to more conventional regional nerve blocks, such as FIB, femoral nerve block, and lumbar plexus block. PENG block is reproducible, easily performed in the preoperative setting, and appears to spare motor function while providing prolonged sensory analgesia.

Results of meniscal injuries repair using different arthroscopic techniques.

AIM: Evaluation of clinical and radiological outcomes following meniscal repair using different arthroscopic techniques for all meniscal tears amenable for repair. METHODS: Sixty-one patients were involved in a prospective study; all cases presented with meniscal tears underwent arthroscopic meniscal repair from December 2016 to December 2017. Outcomes involved the site of tear, the repair technique, and associated injuries. The International Knee Documentation Committee Score (IKDC) and Tegner Lysholm Knee Score were used to analyze the clinical and functional outcomes postoperatively. RESULTS: Of the 61 patients, 50 patients (81.9%) had meniscal tear associated with isolated ligamentous ACL injury, 6 cases had corrective osteotomy with ACL reconstruction to correct concomitant genu varus, 2 cases (3.3%) had meniscal tear associated with isolated ligamentous PCL injury, and 9 patients (14.8%) presented with isolated meniscal tear; IKDC was preoperatively (44.52 ± 8.79), postoperatively at 6 months (90.97 ± 6.75) and at 12 months (92.27 ± 2.68) with P-value (0.001). Tegner Lysholm score was preoperatively (52.16 ± 12.22), postoperatively at 6 months (88.03 ± 6.84) and at 12 months (93.26 ± 2.95) with P-value (0.001). Fifty eight patients (95.1%) had no postoperative symptoms at 6 and 12 months' follow-up. The remaining 3 cases (4.9%) underwent partial meniscectomy due to persistent postoperative clinical symptoms with no signs of healing in MRI. CONCLUSIONS: Our study concluded that arthroscopic meniscal repair is an effective way in the management of meniscal tears regarding clinical and functional outcomes.

Arabic translation and validation of three knee scores, Lysholm Knee Score (LKS), Oxford Knee Score (OKS), and International Knee Documentation Committee Subjective Knee Form (IKDC).

AIM OF THE WORK: Translation and validation of three commonly used knee scores to Arabic language: the Lysholm Knee Score (LKS), the Oxford Knee Score (OKS), and IKDC Subjective Knee Form. METHODS: Our work focused on translation and validation of the LKS, OKS and IKDC. Construct validity was assessed by comparing the LKS, OKS, and IKDC Subjective Knee Form and previous Arabic translated version of Knee injury and Osteoarthritis Outcome Score (KOOS). Test-retest reliability, internal consistency, and construct validity were assessed, using Intraclass Correlation Coefficient (ICC), Cronbach's alpha, and Pearson correlation coefficient (r). RESULTS: Reliability was excellent for the Arabic IKDC subjective form (0.95), while the Arabic LKS and the Arabic OKS were good: 0.8 and 0.85, respectively. The Cronbach's ά was excellent for the Arabic LKS and Arabic OKS: 0.9 and 0.90, respectively, while the Arabic IKDC subjective form was good (0.89). Construct validity was high for the Arabic LKS and the Arabic OKS: 0.7 and 0.913, respectively, while the Arabic IKDC was moderate (0.4) in cases of ACL and meniscus injuries and mild (0.18) in cases of osteoarthritis. CONCLUSION: Arabic LKS and Arabic OKS were reliable and valid scores for patients complaining of ligamentous injuries, meniscus injuries, and osteoarthritis to be used for Arabic-speaking people, while the Arabic IKDC had excellent reliability and mild validity in cases of osteoarthritis and moderate validity in cases of ACL and meniscus injuries.