Total Hip Arthroplasty (THA) Lumbar Plexus Verses Periarticular
| Status: | Completed |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2018 |
| Start Date: | September 2014 |
| End Date: | September 2016 |
Prospective, Randomized Controlled Trial Comparing Continuous Posterior Lumbar Plexus Nerve Block vs Periarticular Injection With Ropivacaine or Liposomal Bupivacaine (Exparel®) on Patients Undergoing Total Hip Arthroplasty
Total hip arthroplasty is a one of the most commonly performed surgical procedures with
increasing numbers anticipated over the next several decades. The purpose of this study was
to find a better way to make patients comfortable after their hip surgery. Three different
ways of providing pain relief were compared, a peripheral nerve block in the lower back
outside of the spinal space (using bupivacaine, a numbing medicine), or injections around the
hip joint with one of two different medicines, either Ropivacaine or Liposomal Bupivacaine
(Exparel®).
increasing numbers anticipated over the next several decades. The purpose of this study was
to find a better way to make patients comfortable after their hip surgery. Three different
ways of providing pain relief were compared, a peripheral nerve block in the lower back
outside of the spinal space (using bupivacaine, a numbing medicine), or injections around the
hip joint with one of two different medicines, either Ropivacaine or Liposomal Bupivacaine
(Exparel®).
Total hip arthroplasty is associated with moderate to severe postoperative pain and an ideal
clinical pathway for pain management has yet to be established. Multimodal pain management
incorporating the use of regional anesthesia for THA has led to decreased hospital length of
stay, improved patient comfort, and enhanced patient satisfaction that is efficacious and
cost-effective. This investigation compared multimodal total joint arthroplasty pathways with
continuous lumbar plexus blockade versus two different periarticular injection mixtures to
potentially determine an ideal perioperative analgesia pathway for THA.
Patients undergoing elective, unilateral primary total hip arthroplasty within a clinical
pathway utilizing preemptive low-dose opioid and non-opioid medications for multimodal
analgesia were randomized to one of three different intervention groups after informed
consent was obtained: posterior lumbar plexus block (PNB), periarticular infiltration (PAI)
with ropivacaine, ketorolac, and epinephrine, and PAI with liposomal bupivacaine, ketorolac,
and epinephrine. The investigators hypothesized differences in the analgesia outcomes between
the three intervention groups would provide for an evidenced-based clinical pathway to emerge
as a result of this study.
clinical pathway for pain management has yet to be established. Multimodal pain management
incorporating the use of regional anesthesia for THA has led to decreased hospital length of
stay, improved patient comfort, and enhanced patient satisfaction that is efficacious and
cost-effective. This investigation compared multimodal total joint arthroplasty pathways with
continuous lumbar plexus blockade versus two different periarticular injection mixtures to
potentially determine an ideal perioperative analgesia pathway for THA.
Patients undergoing elective, unilateral primary total hip arthroplasty within a clinical
pathway utilizing preemptive low-dose opioid and non-opioid medications for multimodal
analgesia were randomized to one of three different intervention groups after informed
consent was obtained: posterior lumbar plexus block (PNB), periarticular infiltration (PAI)
with ropivacaine, ketorolac, and epinephrine, and PAI with liposomal bupivacaine, ketorolac,
and epinephrine. The investigators hypothesized differences in the analgesia outcomes between
the three intervention groups would provide for an evidenced-based clinical pathway to emerge
as a result of this study.
Inclusion Criteria:
1. Adult patients with an American Society of Anesthesiologists (ASA) physiological
status I-III
2. Patients presenting for unilateral primary total hip arthroplasty
3. Patients 18 years of age and older
Exclusion Criteria:
1. Chronic pain syndromes such as fibromyalgia or complex regional pain syndrome
2. History of long term use of daily opioids (>1 months) with Oral Morphine Equivalent
(OME) >5mg/day
3. Body mass index (BMI) > 40 kg/m2
4. Allergies to medications used in this study such as: fentanyl,hydromorphone,
ketorolac, ibuprofen, acetaminophen, local anesthetics, oxycodone, tramadol,
ondansetron, droperidol, dexamethasone, celecoxib and OxyContin
5. Major systemic medical problems such as:
1. severe renal disorder defined as glomerular filtration rate (GFR) <50 units/m2
2. cardiovascular disorders defined as Congestive Heart Failure (CHF) New York Heart
Association (NYHA) class III-IV
3. severe hepatic disorder defined as current or past diagnosis of acute/subacute
necrosis of liver, acute hepatic failure, chronic liver disease, cirrhosis
(primary biliary cirrhosis), fatty liver, chronic hepatitis/toxic hepatitis,
liver abscess, hepatic coma, hepatorenal syndrome, other disorders of liver
6. Impaired cognitive function or inability to understand the study protocol
7. Contraindication to a regional anesthesia technique (e.g., preexisting neuropathy in
the operative extremity, coagulopathy [platelets < 100,000, International Normalized
Ratio (INR) >1.5], refusal, etc.).
8. Previous contralateral hip replacement managed with regional or periarticular
injection
9. Unable to follow-up at the 3 month interval at Mayo Clinic in Rochester, Minnesota
10. Pregnancy or breastfeeding (women of child-bearing potential will require a negative
pregnancy test)
We found this trial at
1
site
200 First Street SW
Rochester, Minnesota 55905
Rochester, Minnesota 55905
507-284-2511
Principal Investigator: Rebecca L Johnson, M.D.
Phone: 507-255-1829
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