Arthropathy of Hip
Conditions
Keywords
Pain, Postoperative, Nerve Block, Anesthesia, Epidural
Brief summary
The goal of this retrospective chart review is to evaluate if the implementation of lumbar plexus block placement for postoperative pain 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, assistance 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
Yes
Inclusion criteria
* 18 years and older * Diagnosis of: 1. Primary THA, (identified by CPT code 27130) 2. Either a) Epidural (CPT code 62319) or b) Lumbar plexus peripheral nerve block (CPT 62311 or 64449) * Perioperative multimodal medication * Hospitalized from July 1, 2012 to December 17, 2014.
Exclusion criteria
* THA Revision * ICU admission postoperatively * History of dementia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opiate Consumption | 48 hours postoperative | Cumulative opiate consumption in intravenous (IV) morphine mg equivalents (MME) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of First Ambulation | 48 hours | Time of first ambulation relative to anesthesia end time (hours) |
Countries
United States
Participant flow
Recruitment details
Inclusion criteria included primary, elective THA with either lumbar epidural (n=547) or lumbar plexus peripheral nerve block (n=219) for postoperative analgesia. Exclusion criteria included THA revision, traumatic fractures, non-elective surgeries, and postoperative ICU admission. 342 epidural &107 lumbar plexus patients met inclusion criteria.
Pre-assignment details
Subjects meeting inclusion criteria were assigned a chronological number based on the date of their operation (Epidural 1-342; Lumbar plexus 1-107) and then randomized using Microsoft Excel. Data were collected on the first 58 randomized subjects in each group; 58 epidural patients and 58 lumbar plexus patients.
Participants by arm
| Arm | Count |
|---|---|
| Lumbar Plexus Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management. | 58 |
| 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. | 58 |
| Total | 116 |
Baseline characteristics
| Characteristic | Lumbar Plexus | Total | Lumbar Epidural |
|---|---|---|---|
| Age, Continuous | 60.4 years STANDARD_DEVIATION 4.5 | 60.8 years STANDARD_DEVIATION 3.76 | 61.3 years STANDARD_DEVIATION 1.99 |
| 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 | 11 Participants | 24 Participants | 13 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 | 47 Participants | 92 Participants | 45 Participants |
| Region of Enrollment United States | 58 participants | 116 participants | 58 participants |
| Sex: Female, Male Female | 35 Participants | 64 Participants | 29 Participants |
| Sex: Female, Male Male | 23 Participants | 52 Participants | 29 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 58 | 0 / 58 |
| other Total, other adverse events | 0 / 58 | 0 / 58 |
| serious Total, serious adverse events | 0 / 58 | 0 / 58 |
Outcome results
Primary
Opiate Consumption
Cumulative opiate consumption in intravenous (IV) morphine mg equivalents (MME)
Time frame: 48 hours postoperative
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lumbar Plexus | Opiate Consumption | 64.8 Opiate Consumption (IV MME) | Standard Error 3.32 |
| Lumbar Epidural | Opiate Consumption | 81.3 Opiate Consumption (IV MME) | Standard Error 4.13 |
Secondary
Time of First Ambulation
Time of first ambulation relative to anesthesia end time (hours)
Time frame: 48 hours
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lumbar Plexus | Time of First Ambulation | 24.6 Hours | Standard Error 2.01 |
| Lumbar Epidural | Time of First Ambulation | 31.7 Hours | Standard Error 1.54 |