Minimal Opioid Use After Total Hip Replacement (THR)

• Status: Completed
• Trial end date: 2019-09-27
• Target enrollment: 0
• Participant gender: All

Summary

Total hip arthroplasty can be associated with significant postoperative pain. Side effects of pain management may impair participation in physical therapy and slow readiness for discharge from the hospital. In a previous study done by the investigators' group, epidural patient controlled analgesia (EPCA) with a hydromorphone containing solution appeared to have a more favorable pain profile with ambulation, but greater side effects compared to injection of a peri-articular cocktail. The use of opioid was greater in the peri-articular injection group (PAI). There was no difference in length of stay. In view of the controversy over opioid use, the investigators would like to develop an optimal opioid sparing pain management approach by comparing 3 different protocols 1) Plain local anesthetic EPCA; 2) PAI; 3) EPCA + PAI; all in conjunction with a multimodal opioid sparing pain regimen. The goal would be to maximize pain control while minimizing opioid use and side-effects.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Hospital for Special Surgery, New York
• Treatments: Analgesics, Opioid; Bupivacaine

Criteria

Inclusion Criteria:

• Any patient with osteoarthritis scheduled for primary total hip arthroplasty with a participating surgeon

• Planned use of regional anesthesia

• Planned posterolateral surgical approach

• Age Range 45-80

• Ability to follow study protocol

Exclusion Criteria:

• Any patient with age <45 or >80

• Any patient with planned anterior surgical approach

• Any patient with prior major ipsilateral hip surgery

• Any patient intending to receive general anesthesia

• Any patient with an ASA of IV

• Any patient with insulin-dependent diabetes

• Any patient with hepatic (liver) failure (history of cirrhosis or elevated LFT's)

• Any patient with chronic renal (kidney) failure (formal diagnosis of renal disease of elevated creatinine)

• Any patient with history of gastric (stomach) ulcer

• Chronic opioid use (taking opioids for >3 mo duration on a daily basis)

• Chronic analgesic use (i.e. lyrica, gabapentin) for >3 mo duration

• Stress dose steroids

• Use of antidepressants

• Contraindications to aspirin

• Allergy to any of the medications (or adhesives) involved in the study protocol

• Dementia

• Non-English speakers.