Opioid-Free Perioperative Analgesia for Revision Total Hip Arthroplasty in a Patient With a History of Substance Use Disorder

TL;DR

This paper describes a successful opioid-free surgical approach for a patient with a history of opioid abuse undergoing hip surgery.

Contribution

The paper presents a novel multimodal analgesia strategy combining regional nerve blocks and nonopioid medications for opioid-free hip surgery.

Findings

Combining regional nerve blocks and nonopioid medications achieved effective pain control.

The patient avoided opioids entirely during and after surgery.

Pain scores were mostly zero during hospitalization.

Abstract

Background: Given the endemic opioid crisis in our communities, there is an important need for opioid-sparing analgesia alternatives for invasive surgical procedures that use multimodal analgesia to help reduce or avoid opioid consumption perioperatively. Unfortunately, a significant challenge exists in reducing opioid consumption with procedures that are known to cause a significant amount of postoperative discomfort. Regional anesthesia via peripheral nerve blockade is a modality that can take advantage of pertinent anatomy, greatly reduce a patient's postoperative pain, and minimize opioid consumption. Some anatomical locations, such as the hip joint, have complex innervation. For such anatomical locations, a single peripheral nerve block may fail to cover all the involved sensory nerves, and thus, incorporating additional regional blocks can synergistically provide sufficient analgesic coverage.

Case Presentation: A 69-year-old man presented for revision total hip arthroplasty. Due to his previous history of opioid abuse, he requested an opioid-free perioperative experience. The patient's past medical history was complex, and he had suffered recurrent prosthetic joint infections. To accomplish opioid-free perioperative analgesia for his revision hip arthroplasty, we utilized both the suprainguinal fascia iliaca block and the pericapsular nerve group block, in combination with surgeon-administered local infiltration analgesia and oral and intravenous nonopioid systemic pain medications. The patient was successfully able to avoid opioids through the procedure and postoperative course, with the majority of his pain scores being zero out of 10 during his hospital admission.

Conclusions: Complimentary regional nerve blocks, when combined with surgeon-administered local infiltration analgesia and multiple systemic nonopioid medications, can provide sufficient analgesia to cover the complexly innervated hip joint and accomplish an opioid-sparing revision total hip arthroplasty perioperative course.

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