Systemic Steroids for Peripheral Nerve Blocks
Condition: Osteoarthritis, Hip
MeSH terms: Osteoarthritis, Hip
Study type: Interventional
Phase: Phase 4

Summary: 
      This study will investigate the ability of systemic dexamethasone to prolong the sensory
      block duration for lumbar plexus nerve blockade.
    

Detailed description: 
      The purpose of this randomized, double-blinded, placebo-controlled trial is to examine the
      equivalency of two different doses of dexamethasone when given intravenously as an adjuvant
      medication for postoperative pain management. Specifically, this study will investigate the
      prolongation of time to recovery of sensation following a lumbar plexus block in patients
      undergoing total hip arthroplasties. The investigators hypothesize that dexamethasone will
      prolong the sensory block time when compared to placebo and that similar results will be
      obtained in the 4 mg arm when compared to the 8 mg arm. The primary end point will be time to
      sensory recovery in the femoral nerve cutaneous distribution (part of the lumbar plexus) as
      determined by pin-prick sensation assessment. Secondary endpoints will include, but are not
      be limited to: time to first opioid administration, total opioid consumption over 30 hours,
      and rest and incident verbal numerical pain scores at 6,12,18,24 and 30 hours post block
      placement.
    

Intervention name(s): Dexamethasone; Bupivacaine; Epinephrine; Lumbar Plexus Nerve Block; Saline
Intervention type(s): Drug; Drug; Drug; Procedure; Drug
Intervention description(s): A lumbar plexus nerve block will be performed for patients undergoing hip arthroplasty. A total of 25cc's of 0.25% bupivacaine with 1:400,000 epinephrine will be administered for postoperative analgesia. Surgical anesthesia will be provided either by an intrathecal spinal block or general anesthesia. Successful blockade will be assumed if the patient has a decrease or loss of pinprick sensation in the femoral nerve distribution, which innervates the anterior thigh. If no evidence of blockade is present, testing will occur again at 30 minutes post block. Testing will be performed with a 25 gauge Whitacre needle and once present the area of testing will be marked with a surgical marking pen so that repeat sensory testing can be undertaken at that same site over the course of the study. The subjects will then receive dexamethasone (4 or 8 mg) or placebo (saline) based on arm placement.; Bupivacaine will be used in lumbar plexus nerve block mixture.; Epinephrine will be used in lumbar plexus nerve block mixture.; This is the procedure that will be performed.; Patients randomized to the placebo group will receive normal saline intravenously.
Other intervention name(s): dexamethasone sodium phosphate injection; Bupivacaine Hydrochloride; Adrenaline; Normal saline, NaCl
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Epinephrine; Bupivacaine; Dexamethasone 21-phosphate; BB 1101
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Arthroplasty, Hip, Replacement; Anesthesia, Local; Anesthesia Conduction; Bupivacaine; Dexamethasone; Preanesthetic Medications; Nerve Block; Lumbar Plexus Block; Analgesia; Glucocorticoids; Local Anesthetics