Meloxicam for Pain Management After Total Joint Arthroplasty (TJA)

Phase 3

Completed

Brief Summary: The purpose of this project is to determine if a change in patient reported pain, nausea and vomiting after total knee and hip arthroplasty could be observed with the substitution of Intravenous meloxicam for ketorolac in the current established peri-operative pain protocol and if these changes lead to a decrease in opioid consumption (in morphine equivalents).

Recruitment & Eligibility

Inclusion Criteria

Patients over the age of 18,
Patients undergoing primary total knee or primary total hip replacement at the University of Miami Hospital,
Patients that have capacity to provide medical consent

Exclusion Criteria

All patients under the age of 18
Prisoners, diabetics, increased risk of bleeding, and pregnant women.
Patients with prior surgery or history of infection on the joint of interest.
Patients with an estimated glomerular filtration rate (eGFR) <50 ml/min
Patients on dialysis or renal transplant.
Patients on steroid preoperatively.
Allergy to sulfas
Inability to provide medical consent.
Any condition that, in the opinion of the investigator, would compromise the well-being of the patient or the study or prevent the patient from meeting or performing study requirements will exclude the participant.

Arm && Interventions

Group	Intervention	Description
IV meloxicam group	IV meloxicam	Participants will receive the institution specific joint replacement pain protocol, however with IV meloxicam substituted for ketorolac.
Ketorolac group	Ketorolac	Participants will receive the institution specific joint replacement pain protocol, including ketorolac.

Primary Outcome Measures

Name	Time	Method
Pain Measured by the Numeric Rating Scale	24 hours postoperatively	A numeric pain rating scale will be used - a higher pain score would indicate higher pain levels. It is scaled 0-10.

Secondary Outcome Measures

Name	Time	Method
Length of Stay as Measured by Same Day Discharges	From surgery until discharge	The number of patients which were able to be discharged home the same day as their surgical procedure
Opioid Consumption as Measured by Morphine Milligram Equivalents (MME)	Within 24 hours postoperatively	The amount of opioids a patient consumes converted into MME for standard comparisons
Renal Injury as Measured by the Change in Creatinine Levels	From preoperative baseline labs while hospitalized, up to 1 week	The change in creatinine levels per patient as by comparing their standard preoperative lab creatinine values with the standard postoperative lab creatinine values before discharge from the hospital after their procedure, up to 1 week postoperatively.
Nausea Score as Measured by a Likert Scale	24 hours postoperatively	Patients select a score to indicate the severity of their nausea. Scores of 0, 1-2, 3-6, and 7-9 indicate no nausea, mild nausea, moderate nausea, and severe nausea, respectively. The score 10 is assigned to vomiting.
Length of Stay as Measured by Hospital Nights	From surgery until discharge	The total number of overnights spent in the hospital between surgery and discharge
Length of Stay as Measured by Hours in the Hospital	Until patient discharged from the hospital	Length of stay for the patient as measured in hours from surgery until the moment of discharge