Pain Management
Conditions
Brief summary
To compare the safety and effectiveness of two pain control pathways following routine orthopaedic surgical procedures (single level or two-level ACDF/ACDA, 1st CMC arthroplasty, Hallux Valgus/Rigidus corrections, diagnostic knee arthroscopies, total hip arthroplasty, and total shoulder arthroplasty / reverse total shoulder arthroplasty). The control group will undergo surgery with an opioid-based pain protocol and the intervention group will undergo surgery with a multimodal, opioid-free protocol. Patients will have data collected with respect to pain scores, overall comfort level, overall satisfaction with the surgical experience and recovery, constipation, falls, and overall satisfaction with pain control, in addition to procedure-specific outcome scores and patient-specific metrics.
Interventions
DRUGOpioids
narcotic pain medicine
DRUGOpioid-Free
non narcotoc pain medication
Sponsors
OrthoCarolina Research Institute, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1\. Patient is scheduled to undergo one of the following procedures: * Primary single-level or two-level ACDF or ACDA for degenerative disease * Primary 1st CMC arthroplasty * Primary Hallux Valgus or Hallux Rigidus correction * Diagnostic knee arthroscopy +/- meniscal debridement * Elective primary total shoulder or reverse total shoulder arthroplasty * Primary total hip arthroplasty
Exclusion criteria
1. Revision surgery for one of the study-specific procedures 2. Chronic opioid therapy - per investigator discretion 3. Significant liver disease - (NOTE: Patients with a history of liver disease will have a hepatic panel drawn to be reviewed by the study investigator to asses if the values are within acceptable limits for inclusion in the study) 4. Fracture or soft tissue injury 5. Sickle cell disease 6. Workers compensation 7. Alcohol dependence 8. Contra-indication to regional anesthesia 9. History of gastrointestinal (GI) bleeding or peptic ulcer 10. History of bleeding problems 11. Patients taking anticoagulants, not including aspirin (only applies to Randomized portion of study. These patients can still participate in Observational Control Group) 12. Renal insufficiency - Creatinine clearance less than 30 mL/min (only applies to patients having surgery requiring NSAIDs treatment) 13. Outpatient THA or TSA/RTSA 14. Hammertoe in isolation (Hallux Valgus/Rigidus exclusion only) 15. Concomitant meniscal repair or microfracture (Knee Arthroscopy exclusion only) 16. Ineligible for spinal anesthesia (THA exclusion only) 17. Previous ipsilateral hip surgery, not including hip scope (THA exclusion only) 18. Allergy to non-steroidal anti-inflammatory medications (NSAIDs)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain at 24 hours postop | 24 hours | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain at 12 hours postop | 12 hours | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
| Pain at 2 weeks postop | 2 weeks | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
| Pain at 6 hours postop | 6 hours | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
| Pain at 1 year postop | 1 year | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
| General Health | 1 year | Veterans Rand-12 |
| Pain at 6 weeks postop | 6 weeks | Numeric Pain Rating Scale 0-10, with 10 representing the highest/worst pain score |
Countries
United States
Outcome results
None listed