EP3.46 Association of Intra-articular Analgesic Injection Timing With Perioperative Analgesic Requirements Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome

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ID: 331043
2026
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Abstract
Abstract Background Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is often followed by substantial postoperative pain despite multimodal analgesia. Whether peri-articular analgesic injection at the beginning of surgery (BOS) versus the end of surgery (EOS) influences perioperative opioid requirements remains unclear. The purpose of this study was to compare opioid use and early recovery between BOS and EOS timing using a four-cohort design. We hypothesized BOS would be associated with lower opioid requirements and shorter postanesthesia care unit (PACU) recovery. Methods We reviewed 315 consecutive FAIS hip arthroscopy cases at a single academic center from February 2024 to May 2025. Two orthopaedic surgeons participated. Surgeon A changed from EOS (n = 72) to BOS (n = 72) during the study period. Surgeon B used only BOS and was divided at the same cutoff into Early BOS (n = 81) and Late BOS (n = 90) as a temporal control. Opioid consumption was converted to morphine milligram equivalents (MME) for the preoperative, intraoperative, and PACU phases and summed for total perioperative MME. Surgery duration, PACU length of stay, and preoperative opioid exposure were also recorded. Groups were compared with Kruskal-Wallis and chi-square or exact tests. Four planned pairwise comparisons were assessed at a Bonferroni-corrected threshold of p < 0.0125. Results Cohorts differed in preoperative MME (p < 0.001), intraoperative MME (p=0.028), PACU MME (p = 0.035), and total perioperative MME (p = 0.006). However, none of the four planned pairwise comparisons for intraoperative, PACU, or total MME reached significance after correction. Preoperative oxycodone use differed between early and late periods within both surgeons (both p < 0.01), consistent with changes in practice over time rather than injection timing. Preoperative opioid exposure within 2 months (p = 0.896) and PACU length of stay (p = 0.407) didn’t differ across cohorts. Conclusions In this four-cohort analysis, BOS versus EOS injection timing was not consistently associated with lower perioperative opioid requirements or shorter PACU recovery. These findings did not support our hypothesis that BOS timing would reduce opioid use and shorten PACU recovery. Differences observed across cohorts appeared more consistent with temporal changes in perioperative protocols than with injection timing itself.
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Authors Mateusz Szlembarski, William Vasileff, John Ryan, Tyler Barker, Soham Barot
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.331
URL
https://doi.org/10.1093/jhps/hnag043.331
Keywords Keywords not found

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