Position: Supine, Trendelenburg
Time: 2-4 hours (long)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: High (7-10)
Maintenance Paralytic: Yes

Blocks: Fascia Illiaca, PENG

Preoperative – make sure the patient knows that they will likely wake up in PACU with pain. Warnings should also be given that there may be numbness in the toes which can take 1-2 days to resolve.

GETT approach preferred – traction is a very common standard for these procedures. This and the trendelenburg position makes GETA the safest approach.

Pain Control – Hip FAI correction and acetabuloplasty or femoroplasty has a lot of intraop and postoperative pain control issues. As long as the preoperative blocks are effective, little to no opioids should required during the procedure. Foot/calf/back pain caused by traction can be intractable, so it is advised to give some coverage (eg ~0.5mg hydromorphone) at the end of case.

Blocks – PENG block offers great hip capsule pain control and can last 3+ days but needs a LFC to cover 2-3 port site pain in the quadriceps. Fascia Illiaca was the old standard of care but with increased fall risk and only minimal to moderate pain control, PENG will be new standard of care.

Labrum repair – almost always performed.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.