Arthritis, Arthroplasty, Replacement, Hip
Conditions
Keywords
Arthroplasty, Replacement, Hip
Brief summary
The goal of this retrospective chart review is to evaluate if the implementation of lumbar plexus block placement for postoperative pain and administration of multimodal oral analgesia have improved conditions in the postoperative period for patients undergoing total hip arthroplasty when compared to the placement of epidurals for postoperative pain management.
Detailed description
Primary outcome: 48 hour opiate consumption in patients following THA. ' Secondary outcome: Time to first ambulation, assitstance needed with ambulation, opiate and regional related side effects, time to discharge orders.
Interventions
None listed
Sponsors
Medical University of South Carolina
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Primary total hip arthroplasty, (identified by current procedural terminology (CPT) code 27130) and 2. Either a) Epidural or b) Lumbar plexus peripheral nerve block with the administration of multimodal medication after July 2012. \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opiate Consumption | 48 hours postoperative | Cumulative 48 Hours Opiate Consumption in Intravenous (IV) Morphine mg Equivalents (MME) |
Countries
United States
Participant flow
Recruitment details
Inclusion criteria consisted of primary elective THA surgery with either (1) a lumbar epidural (n = 51) or (2) a lumbar plexus peripheral nerve block (n = 312) for postoperative analgaesia. Exclusion criteria were THA revision, traumatic fractures, nonelective surgery, general anaesthesia, and post-operative intensive care unit (ICU) admission.
Pre-assignment details
Of the charts reviewed, 31 lumbar epidural and 153 lumbar plexus patients met inclusion criteria and were assigned a chronological number based on the date of their operation (Epidural 1-31; Lumbar plexus 1-153). These numbered lists were then randomised and data collected on the first 24 randomised patients for each block type.
Participants by arm
| Arm | Count |
|---|---|
| Lumbar Plexus Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management with one to four multimodal oral pain medications (acetaminophen, celecoxib, oxycodone ER, gabapentin, pregabalin) administered preoperatively or in the first 48 hours postoperatively. | 24 |
| Lumbar Epidural Patients received a lumbar epidural preoperatively for postoperative pain management. Epidural infusions of ropivacaine 0.2% were initiated intraoperatively, administered until the morning of postoperative day 1, and titrated to patient comfort. | 24 |
| Total | 48 |
Baseline characteristics
| Characteristic | Lumbar Epidural | Total | Lumbar Plexus |
|---|---|---|---|
| Age, Continuous | 61.2 years STANDARD_DEVIATION 2.55 | 61.65 years STANDARD_DEVIATION 2.44 | 62.1 years STANDARD_DEVIATION 2.32 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 7 Participants | 6 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 23 Participants | 41 Participants | 18 Participants |
| Sex: Female, Male Female | 12 Participants | 25 Participants | 13 Participants |
| Sex: Female, Male Male | 12 Participants | 23 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 24 | 0 / 24 |
| other Total, other adverse events | 0 / 24 | 0 / 24 |
| serious Total, serious adverse events | 0 / 24 | 0 / 24 |
Outcome results
Primary
Opiate Consumption
Cumulative 48 Hours Opiate Consumption in Intravenous (IV) Morphine mg Equivalents (MME)
Time frame: 48 hours postoperative
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lumbar Plexus | Opiate Consumption | 48.6 IV MME | Standard Error 5.21 |
| Lumbar Epidural | Opiate Consumption | 53.9 IV MME | Standard Error 6.31 |