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THA Lumbar Plexus Verses Periarticular

Overview

About this study

Total hip arthroplasty is a one of the most commonly performed surgical procedures with increasing numbers anticipated over the next several decades. Differences in the analgesia outcomes between these three intervention groups would provide for an evidenced-based clinical pathway that will emerge as a result of this study.

Hypothesis:

Patients undergoing total hip arthroplasty within a clinical pathway utilizing preemptive low-dose opioid and non-opioid medications for multimodal analgesia randomized to peripheral nerve blockade will report less pain with movement on an NRS scale POD #1 compared to randomization to periarticular injection with ropivacaine mixture or periarticular injection with liposomal bupivacaine (Exparel®).

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion:

  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:

  1. Chronic pain syndromes such as fibromyalgia or complex regional pain syndrome
  2. History of long term use of daily opioids (>1 months) with 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 CHF 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, 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, MN
  10. Pregnancy or breastfeeding (women of child-bearing potential will require a negative pregnancy test

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status

Rochester, Minn.

Mayo Clinic principal investigator

Rebecca Johnson, M.D.

Closed for enrollment

More information

Publications

Publications are currently not available

More about research at Mayo Clinic

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CLS-20142715

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