Psoas Compartment Block Versus Periarticular Local Anesthetic for Total Hip Arthroplasty

Phase 4

Completed

Interventions: Drug: Ropivacaine with NaCl
Drug: Epinephrine
Drug: Morphine
Drug: Ketorolac Tromethamine
Drug: Ropivacaine

Brief Summary: The primary objective of this study is to examine whether there is a difference in the level of resting pain following total hip arthroplasty with an anterior approach with use of a psoas compartment block versus a local periarticular anesthetic infiltration

Detailed Description: A single-center, prospective, randomized clinical trial with a total of 100 patients. One orthopaedic adult reconstruction surgeon at Beaumont Hospital Royal Oak (JJV) will perform all surgeries. After the patient has consented they will be randomized to one of the following two groups:

1. Psoas compartment block (n=50)

2. Periarticular local anesthetic infiltration (n=50),

The patient will be blinded to the study group.

Recruitment & Eligibility

Inclusion Criteria

Patients undergoing unilateral primary total hip arthroplasty by Dr. James Verner at Beaumont Hospital Royal Oak
Have a diagnosis of primary osteoarthritis (i.e. degenerative joint disease)
Surgical approach is anterior

Exclusion Criteria

Minors (age less than 18 years)
Pregnant (surgically sterile, post-menopausal, or negative blood test)
Previous ipsilateral hip surgery
Lumbar instrumentation
Acute trauma
Rheumatoid arthritis
Avascular necrosis
Hip dysplasia
Known sensitivity, allergy, or contraindication to anesthetics being used in the study
Narcotic sensitivity
History of over 6 months of opioid dependency prior to surgery (excluding tramadol)
Peripheral neuropathy
Mental/cognitive impairment that would interfere with the patient's self-assessments of function, pain, or quality of life

Arm && Interventions

Group	Intervention	Description
Psoas Compartment Block	Ropivacaine with NaCl	After exposure anesthetic (Ropivacaine with NaCl) is introduced directly into the iliopsoas muscle, where it then spreads to the lumbar plexus (the nerves responsible for sensation around the surgical site).
Periarticular Local Anesthetic	Morphine	An anesthetic "cocktail" of four drugs (ropivacaine, epinephrine, ketorolac tromethamine, morphine) is injected at five locations at the surgical site to the surrounding tissues.
Periarticular Local Anesthetic	Epinephrine	An anesthetic "cocktail" of four drugs (ropivacaine, epinephrine, ketorolac tromethamine, morphine) is injected at five locations at the surgical site to the surrounding tissues.
Periarticular Local Anesthetic	Ropivacaine	An anesthetic "cocktail" of four drugs (ropivacaine, epinephrine, ketorolac tromethamine, morphine) is injected at five locations at the surgical site to the surrounding tissues.
Periarticular Local Anesthetic	Ketorolac Tromethamine	An anesthetic "cocktail" of four drugs (ropivacaine, epinephrine, ketorolac tromethamine, morphine) is injected at five locations at the surgical site to the surrounding tissues.

Primary Outcome Measures

Name	Time	Method
Pain Score at 3 Hours	3 hours postoperative	Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain

Secondary Outcome Measures

Name	Time	Method
Pain Score at 3-24 Hours	measured once during time frame 3 hours-24 hours postoperative	Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain
Pain Score at 24-48 Hours	measured once during time froma 24-48 hours postoperative	Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain
Opioid Usage In-hospital at 24 Hours	24 hours postoperatively	Total amount of opioids used per patient (measured with Morphine Equivalent Units)
Opioid Usage In-hospital at 48 Hours	48 hours postoperatively	Total amount of opioids used per patient (measured with Morphine Equivalent Units)