Postoperative Pain Management
Conditions
Keywords
Hip Surgery, Nerve block
Brief summary
The investigators are evaluating postoperative outcomes in patients undergoing hip replacement surgery performed with either spinal or general anesthesia, who also receive a suprainguinal fascia iliaca block using either perineural ropivacaine alone or ropivacaine combined with dexmedetomidine.
Detailed description
Patients undergoing hip replacement surgery often receive a single-shot suprainguinal fascia iliaca block as a part of the primary anesthetic and multimodal postoperative analgesic strategy. However, the analgesic effect of a single-shot block typically diminishes after several hours and may be inconsistent beyond 24 hours. Adding dexmedetomidine, an alpha-2 agonist, to the local anesthetic has been shown to prolong block duration and reduce postoperative opioid requirements. Investigating its use in suprainguinal fascia iliaca blocks for total hip arthroplasty may clarify its clinical effectiveness. The investigators hypothesize that patients receiving ropivacaine with dexmedetomidine will have a significantly longer time to first analgesic request compared to those receiving ropivacaine alone.
Interventions
DRUGDexmedetomidine
Participants in the experimental arm receive a preoperative suprainguinal fascia iliaca block consisting of 30 mL of 0.25% ropivacaine combined with perineural dexmedetomidine at a dose of 1 mcg/kg.
DRUGRopivacaine
In the experimental arm, ropivacaine (30 mL of 0.25%) is administered with dexmedetomidine. In the active comparator arm, ropivacaine (30 mL of 0.25%) is administered alone without any dexmedetomidine medication.
Sponsors
Rhode Island Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing elective total hip arthroplasty * 18-80 years old * ASA 1-3 classifications
Exclusion criteria
* ASA classification of 4 or greater * Infection at the site of nerve blockade * Coagulopathy * Known allergy to study medications * Chronic opioid consumption (\>3 months) * Currently using lidocaine patches * Pre-existing neuropathy * A history of CVA * High grade atrioventricular block (cardiac conduction system impairment) * Organ dysfunction (cardiac failure, respiratory failure, end stage renal disease, hepatic dysfunction, hypoalbuminemia) * Morbid obesity (≥40 kg/m2) * Prior surgery in supra and/or infrainguinal region * Non-English-speaking participants
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Time of administration of first analgesic after the surgery | Time to first analgesic request, defined as the interval (in minutes) from block administration to the first request for rescue analgesia, assessed for up to 24 hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption (converted to morphine milligram equivalents) | From the start of surgery through 48 hours postoperatively | Intraoperative period; PACU; and at 6, 12, 24, and 48 hours following surgery. |
| Quality of Recovery | 24 hours | The QoR-15 questionnaire has 15 questions that assess patient-reported quality of a patient's postoperative recovery using a 11-point numerical rating scale that leads to a minimum score of 0 (poor recovery) and a maximum score of 150 (excellent recovery). |
| Pain Scores | Up to two hours [post anesthesia recovery unit], 6 hours, 12 hours, 24 hours and 48 hours after surgery | Patients will be asked to rate their pain score on a 11-point scale (0 = no pain to 10 = excruciating pain). |
Countries
United States
Contacts
CONTACTVendhan Ramanujam, M.D.
Outcome results
None listed