Systemic Steroids for Peripheral Nerve Blocks
Condition: Osteoarthritis, Hip
MeSH terms: Osteoarthritis, Hip
Intervention: Dexamethasone; Bupivacaine; Epinephrine; Lumbar Plexus Nerve Block; Saline
Intervention description: 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.
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Epinephrine; Bupivacaine; Dexamethasone 21-phosphate; BB 1101
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Enrollment: 115.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Arthroplasty, Hip, Replacement; Anesthesia, Local; Anesthesia Conduction; Bupivacaine; Dexamethasone; Preanesthetic Medications; Nerve Block; Lumbar Plexus Block; Analgesia; Glucocorticoids; Local Anesthetics

Summary:

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

Eligibility criteria:

        Inclusion Criteria: Primary elective total hip arthroplasty surgery

          -  must be a candidate for placement of a lumbar plexus block under anatomic landmark
             technique using electrical stimulation

          -  must give written informed consent for anesthesia

          -  must also be reliable and able to give accurate verbal pain scores postoperatively

        Exclusion Criteria:

          -  contraindications to regional anesthesia including, allergy to amide local
             anesthetics, presence of peripheral neurologic dysfunction, pre-existing coagulopathy
             or infection in the area of interest will be excluded.

          -  insulin and non-insulin dependent diabetes mellitus

          -  preoperative use of systemic corticosteroids within 30 days of surgery

          -  chronic opioid use (defined as daily opioid dose of greater than 40 mg of oxycodone
             equivalents or any long-acting opioid)

          -  pregnancy

          -  failure to effectively place the lumbar plexus block.

          -  known prior adverse reaction to dexamethasone (for example: psychosis) or an allergy
             to dexamethasone