Total Hip Arthroplasty (THA) Lumbar Plexus Verses Periarticular
Condition: Total Hip Arthroplasty
Intervention: PNB Bupivacaine; PAI Ropivacaine; PAI liposomal bupivacaine; Epinephrine; Ketorolac
Intervention description: Infusion; Injection; Injection; Injection, weight-based dosage of 100 mcg - 300 mcg; Injection, 30 mg
Intervention MeSH terms: Ketorolac; Epinephrine; Bupivacaine; Ropivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 165.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      Total hip arthroplasty is a one of the most commonly performed surgical procedures with
      increasing numbers anticipated over the next several decades. The purpose of this study was
      to find a better way to make patients comfortable after their hip surgery. Three different
      ways of providing pain relief were compared, a peripheral nerve block in the lower back
      outside of the spinal space (using bupivacaine, a numbing medicine), or injections around the
      hip joint with one of two different medicines, either Ropivacaine or Liposomal Bupivacaine
      (Exparel®).
    

Eligibility criteria:

        Inclusion Criteria:

          1. Adult patients with an American Society of Anesthesiologists (ASA) physiological
             status I-III

          2. Patients presenting for unilateral primary total hip arthroplasty

          3. Patients 18 years of age and older

        Exclusion Criteria:

          1. Chronic pain syndromes such as fibromyalgia or complex regional pain syndrome

          2. History of long term use of daily opioids (>1 months) with Oral Morphine Equivalent
             (OME) >5mg/day

          3. Body mass index (BMI) > 40 kg/m2

          4. Allergies to medications used in this study such as: fentanyl,hydromorphone,
             ketorolac, ibuprofen, acetaminophen, local anesthetics, oxycodone, tramadol,
             ondansetron, droperidol, dexamethasone, celecoxib and OxyContin

          5. Major systemic medical problems such as:

               1. severe renal disorder defined as glomerular filtration rate (GFR) <50 units/m2

               2. cardiovascular disorders defined as Congestive Heart Failure (CHF) New York Heart
                  Association (NYHA) class III-IV

               3. severe hepatic disorder defined as current or past diagnosis of acute/subacute
                  necrosis of liver, acute hepatic failure, chronic liver disease, cirrhosis
                  (primary biliary cirrhosis), fatty liver, chronic hepatitis/toxic hepatitis,
                  liver abscess, hepatic coma, hepatorenal syndrome, other disorders of liver

          6. Impaired cognitive function or inability to understand the study protocol

          7. Contraindication to a regional anesthesia technique (e.g., preexisting neuropathy in
             the operative extremity, coagulopathy [platelets < 100,000, International Normalized
             Ratio (INR) >1.5], refusal, etc.).

          8. Previous contralateral hip replacement managed with regional or periarticular
             injection

          9. Unable to follow-up at the 3 month interval at Mayo Clinic in Rochester, Minnesota

         10. Pregnancy or breastfeeding (women of child-bearing potential will require a negative
             pregnancy test)