From the Guidelines
Muscle relaxants should not be routinely combined with opioids for the management of femoroacetabular impingement in the emergency department setting due to the increased risk of mortality and morbidity associated with co-prescribing these agents. The management of femoroacetabular impingement (FAI) in the emergency department setting should focus on pain control with NSAIDs such as ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily), along with acetaminophen (1000mg every 6 hours) for breakthrough pain, as recommended by recent guidelines 1. If muscle spasm is a significant component of the presentation, muscle relaxants like cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 6 hours) can be considered for a short duration (3-5 days), but they should not be combined with opioids due to the increased risk of respiratory depression and death 1.
Some key points to consider when managing FAI in the emergency department setting include:
- Pain control with NSAIDs and acetaminophen
- Avoiding the combination of muscle relaxants and opioids
- Using muscle relaxants for a short duration (3-5 days) if necessary
- Advising patients to rest, apply ice, and avoid activities that worsen symptoms
- Arranging orthopedic follow-up within 1-2 weeks for specialized management, including physical therapy, imaging studies, and possibly surgical intervention, as FAI often requires a comprehensive treatment plan 1.
It's essential to prioritize the safety of patients and avoid co-prescribing muscle relaxants and opioids, given the significant increased risk of death associated with this combination, as highlighted in recent studies and guidelines 1.
From the Research
Management of Femoroacetabular Impingement at the ED
- The management of femoroacetabular impingement (FAI) syndrome typically involves either physiotherapist-led therapy or surgical intervention 2.
- Conservative treatment is usually considered first-line treatment for mild to moderate FAI syndrome, and may include exercises aimed at optimizing movement patterns of the hip and pelvis, activity modification, and analgesia 2, 3.
- Surgical management, usually done arthroscopically, involves resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions, or ligamentum teres tears 4, 2, 5.
Use of Muscle Relaxers
- There is no direct evidence in the provided studies to support the use of muscle relaxers in the management of FAI syndrome at the ED.
- However, analgesia is mentioned as part of the conservative treatment approach for FAI syndrome 2, which may include the use of pain relief medications, but the specific use of muscle relaxers is not mentioned.
Treatment Outcomes
- Studies have shown that both arthroscopic treatment and physical therapy can be beneficial for patients with FAI syndrome, with surgical approaches seeming to offer superior short-term results compared to conservative care only 3.
- Exercise therapy has been shown to be effective in improving hip function, strength, and morphology in some patients with FAI syndrome, with about half of patients responding well to exercise therapy in the short term 6.