Comparative Effectiveness and Safety of Epidural Anesthesia, Intra-articular Injection, and Local Infiltration Analgesia in Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Abstract

Hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) often results in substantial postoperative pain, necessitating effective analgesic strategies. While epidural anesthesia (Epi), intra-articular injection (IA), and local infiltration analgesia (LIA) are commonly used, direct comparisons of their efficacy and safety in this population remain limited. This study aimed to retrospectively compare these three modalities with respect to postoperative pain, opioid consumption, and adverse events of Epi, IA, and LIA in patients undergoing hip arthroscopic surgery for FAIS. This single-center retrospective cohort study included 136 FAIS patients who underwent hip arthroscopic surgery and received either Epi (n=43), IA (n=47), or LIA (n=46). Postoperative pain intensity was the primary outcome, assessed using the Wong-Baker FACES Pain Rating Scale at 0, 12, 24, and 48 hours postoperatively. Secondary outcomes included intraoperative opioid consumption, additional postoperative analgesic requirements, anesthesia induction time, operating room occupancy, and perioperative adverse events. Epidural anesthesia provided statistically significantly superior early postoperative analgesia and reduced intraoperative fentanyl use compared to IA and LIA (p < 0.01). However, epidural anesthesia was associated with statistically significantly longer anesthesia induction time compared to both IA and LIA (p < 0.01), and longer operating room occupancy time compared to IA (p < 0.01). IA showed intermediate postoperative pain control, whereas the incidence of postoperative nausea and vomiting was significantly higher in the LIA group than in the Epi group (p = 0.01). No major epidural-related complications were observed. In hip arthroscopic surgery for FAIS, epidural anesthesia provides superior analgesia and reduces opioid use compared with IA and LIA; however, risks, induction time, and longer induction time and resource utilization may limit use. IA shows greater efficacy than LIA. Analgesic selection should balance efficacy, safety, and resources, and further studies are needed to refine non-epidural strategies. IRB: Institutional Review Board approval number: UOEHCR24-091 (approved December 23, 2024). Level III.