Periarticular Injection Versus Peripheral Nerve Block in Total Hip Arthroplasty

Yale University

Status and phase: Completed; Phase 2

Conditions: Hip Arthropathy

Treatments: Drug: Dex; Procedure: Nerve Block; Drug: Ropivacaine; Procedure: Periarticular Injection (PAI)

Study type: Interventional

Funder types: Other

Identifiers

NCT03977454

2000025198

Details and patient eligibility

About

This study will assess if preoperative quadratus lumborum block (QLB)/lateral femoral cutaneous nerve block (LFCNB) with ropivacaine and glucocorticoids provide more effective analgesia than periarticular injection (PAI) with the same mixture in total hip arthroplasty (THA).

Full description

To support our hypothesis that preoperative quadratus lumborum block (QLB)/lateral femoral cutaneous nerve block (LFCNB) provides more effective analgesia than periarticular injection (PAI) in total hip arthroplasty (THA), we will look at the following outcomes:

Primary outcome: Daily opioid consumption

Secondary outcomes:

Pain intensity and physical functioning while in the hospital: using pain inventory modified from Brief Pain Inventory and Length of hospital stays.

Since both QLB/LFCNB nerve block and PAI techniques are both routinely used as standard of care anesthesia for THA, the study intervention will be the randomization to assign patients to one of these treatment options and assess their response from post-op patient questionnaires and data collection.

When results were entered, the detailed description was updated to reflect the outcome measures used in the study.

Enrollment: 192 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Elective unilateral primary THA
• All surgical approaches
• American Society of Anesthesiologist (ASA) status I, II and III.

Exclusion criteria

• Patient refusal;
• Age less than 18 years
• Those with cognitive dysfunction, psychiatric disorder, or non-English speaking patients that cannot consent or communicate clear understanding of the protocol with research team;
• Coagulopathy;

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

192 participants in 2 patient groups

Group 1 patients will receive nerve block per standard of care

Experimental group

Description:

Nerve blocks (QLB/LFCNB) to be placed preoperatively with dexamethasone sodium phosphate (DEX) and methylprednisolone acetate (MPA), per standard of care of anesthesia block service. 1. QLB: 40ml 0.2% ropivacaine with 5 mg DEX/ 40 mg MPA; and 2. LFCNB: 20ml 0.2% ropivacaine with 5 mg DEX/ 40 mg MPA Preoperatively, Group 1 patients will receive nerve block per standard of care as stated above. Intraoperatively, Group 1 will NOT receive PAI.

Treatment:

Procedure: Nerve Block

Drug: Ropivacaine

Group 2 will NOT receive any nerve blocks.

Active Comparator group

Description:

Intraoperatively, the surgeon will perform PAI with exactly the same medication as group 1, ie, 60 ml 0.2% ropivacaine and 10 mg DEX/ 80 mg MPA, per standard of care of Surgeon.

Treatment:

Drug: Ropivacaine

Procedure: Periarticular Injection (PAI)

Drug: Dex