Minimal Opioid Use After Total Hip Replacement (THR)
Condition: Osteoarthritis, Hip
MeSH terms: Osteoarthritis, Hip
Intervention: Periarticular injection (Deep injection); Periarticular injection (Superficial injection); Bupivacaine; Placebo
Intervention description: Deep injection of "cocktail" containing Bupivacaine with Epi, 30mL; Morphine, 8mg/mL, 1mL; Methyprednislone, 40mg/mL, 1mL; Cefazolin, 500mg in 10 mL; saline, 22mL into the anterior capsule, the periosteum, the gluteus maximus, and the abductor muscles and fascia lata.; Superficial injection of 40mL 0.25% Bupivacaine into subcutaneous tissue prior to wound closure.; EPCA: Bupivacaine 0.06%.; EPCA: Saline.
Intervention MeSH terms: Bupivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Enrollment: 180.0
Sex: All
Minimum age: 50 Years
Maximum age: 75 Years
Healthy volunteers: No
Keywords: Total Hip Replacement; Total Hip Arthroplasty

Summary:

      Total hip arthroplasty can be associated with significant postoperative pain. Side effects of
      pain management may impair participation in physical therapy and slow readiness for discharge
      from the hospital. In a previous study done by the investigators' group, epidural patient
      controlled analgesia (EPCA) with a hydromorphone containing solution appeared to have a more
      favorable pain profile with ambulation, but greater side effects compared to injection of a
      peri-articular cocktail. The use of opioid was greater in the peri-articular injection group
      (PAI). There was no difference in length of stay. In view of the controversy over opioid use,
      the investigators would like to develop an optimal opioid sparing pain management approach by
      comparing 3 different protocols 1) Plain local anesthetic EPCA; 2) PAI; 3) EPCA + PAI; all in
      conjunction with a multimodal opioid sparing pain regimen. The goal would be to maximize pain
      control while minimizing opioid use and side-effects.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Any patient with osteoarthritis scheduled for primary total hip arthroplasty with a
             participating surgeon

          -  Planned use of regional anesthesia

          -  Planned posterolateral surgical approach

          -  Age Range 45-80

          -  Ability to follow study protocol

        Exclusion Criteria:

          -  Any patient with age <45 or >80

          -  Any patient with planned anterior surgical approach

          -  Any patient with prior major ipsilateral hip surgery

          -  Any patient intending to receive general anesthesia

          -  Any patient with an ASA of IV

          -  Any patient with insulin-dependent diabetes

          -  Any patient with hepatic (liver) failure (history of cirrhosis or elevated LFT's)

          -  Any patient with chronic renal (kidney) failure (formal diagnosis of renal disease of
             elevated creatinine)

          -  Any patient with history of gastric (stomach) ulcer

          -  Chronic opioid use (taking opioids for >3 mo duration on a daily basis)

          -  Chronic analgesic use (i.e. lyrica, gabapentin) for >3 mo duration

          -  Stress dose steroids

          -  Use of antidepressants

          -  Contraindications to aspirin

          -  Allergy to any of the medications (or adhesives) involved in the study protocol

          -  Dementia

          -  Non-English speakers.