At a glance
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Minimal Opioid Use After Total Hip Replacement (THR): a Blinded Randomized Placebo-controlled Study
In Brief
A Phase 4 clinical trial evaluating Periarticular injection (Deep injection), Periarticular injection (Superficial injection), and 2 other interventions for Osteoarthritis, Hip. Completed, enrolled 180 participants across 1 site.
Detailed 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.
Study Details
Timeline
Interventions
Deep injection of "cocktail" containing Bupivacaine with Epi, 30mL; Morphine, 8mg/mL, 1mL; Methyprednislone, 40mg/mL, 1mL; Cefazolin, 500mg in 10 mL; saline, 22mL into the anterior capsule, the periosteum, the gluteus maximus, and the abductor muscles and fascia lata.
Superficial injection of 40mL 0.25% Bupivacaine into subcutaneous tissue prior to wound closure.
EPCA: Bupivacaine 0.06%.
EPCA: Saline.