Does Ischemic Preconditioning of the Operative Limb Reduce Pain After Hip Arthroscopy? A Prospective, Single-Blind, Randomized Controlled Trial.

Abstract

Background: Ischemic preconditioning (IPC) involves brief periods of circulatory occlusion and reperfusion to stimulate protective effects on tissues. Studies on IPC prior to knee surgery have shown improvements in postoperative pain and decreased opioid consumption. Through a combination of neural and circulating humoral factors, IPC has also been shown to have systemic effects outside the area of ischemia.

Purpose: To determine whether preoperative IPC of the operative limb at the thigh affects postoperative pain scores or opioid consumption after hip arthroscopy.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: Adult patients undergoing hip arthroscopy for femoroacetabular impingement or labral tear were prospectively enrolled and randomized to IPC or control groups. Limb preconditioning was performed within 24 hours before surgery using the Delphi Personalized Tourniquet System with the cuff on the proximal thigh. The IPC group received a 30-minute treatment consisting of 3 rounds of 5 minutes at limb occlusion pressure alternating with 5 minutes of reperfusion. The control group received the same protocol at 20% of limb occlusion pressure. Arthroscopy was performed according to standard of care. Surveys were administered through RedCap starting the day of surgery through postoperative day 7. Patients were asked to rate their pain from 0 to 10 with the visual analog scale (VAS) and to record use of pain medication. Statistical analysis included chi-square and t tests.

Results: A total of 68 patients (34 IPC, 34 control) were enrolled. Demographic characteristics and specific surgical procedures were similar between groups. Survey compliance was higher in the IPC group than the control group, 6.3 ± 2.7 days versus 3.7 ± 3.38 days, respectively (P < .05). Both groups reported significant reductions in their VAS pain scores from the day of surgery to postoperative day 7 (P < .05). No significant difference was found between the groups in VAS pain scores at any time point. No significant difference was found between the groups in mean daily opioid consumption (expressed as morphine milligram equivalents) or acetaminophen consumption.

Conclusion: IPC of the operative limb at the thigh did not appear to decrease pain scores or pain medication use after hip arthroscopy. This study suggests that although IPC of the limb at the level of the thigh may be useful for some orthopaedic procedures, it may not have a significantly beneficial effect for hip arthroscopy patients.

Registration: NCT04925791 (ClinicalTrials.gov identifier).