3 Local Anesthetics for Spinal Anesthesia in Primary Total Hip Arthroplasty
Condition: Osteoarthritis, Hip
MeSH terms: Osteoarthritis, Hip
Intervention: isobaric bupivacaine; hyperbaric bupivacaine; isobaric mepivacaine
Intervention description: The anesthesiologist and CRNA or resident performing the spinal will perform spinal anesthesia according to standard operating procedures with the randomly assigned local anesthetic.; TThe anesthesiologist and CRNA or resident performing the spinal will perform spinal anesthesia according to standard operating procedures with the randomly assigned local anesthetic.; The anesthesiologist and CRNA or resident performing the spinal will perform spinal anesthesia according to standard operating procedures with the randomly assigned local anesthetic.
Intervention MeSH terms: Bupivacaine; Mepivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients who agree to participate will then be randomized by a computer-generated sequence to one of the three study groups.
Dosing will be as follows: isobaric bupivacaine 12.5 mg (2.5 cc of 0.5%) for ≤ 74" height and 15 mg (3 cc) for > 74" height; hyperbaric bupivacaine 10.25 mg (1.5 cc 0.75%) for ≤ 74" height and 13.125 mg (1.75 cc) for > 74" height; and isobaric mepivacaine 52.5 mg (3.5 cc of 1.5%) for ≤ 74" height and 60 mg (4 cc) for > 74" height.
Masking: Double (Participant, Outcomes Assessor)
Masking description: The anesthesiologist and certified registered nurse anesthetist or resident performing the spinal will be aware of group allocation and will perform spinal anesthesia according to standard operating procedures with the assigned local anesthetic.
Patients will remain blinded and surgeons and those performing postoperative assessments will remain blinded as well.
Enrollment: 159.0
Sex: All
Minimum age: 18 Years
Maximum age: 84 Years
Healthy volunteers: No

Summary:

      Spinal anesthesia is commonly utilized for hip replacement surgery. Different medications
      used for spinal anesthesia work for different lengths of time. This study will compare three
      different spinal anesthesia medications in patients having hip replacement surgery to see if
      patients are able to get out of bed and walk earlier after surgery with one medication versus
      the others.
    

Eligibility criteria:

        Inclusion Criteria:

          -  undergoing elective primary hip replacement surgery

          -  American Society of Anesthesiologists physical status 1-3

        Exclusion Criteria:

          -  hip fracture

          -  contraindication to spinal anesthesia (refusal, coagulopathy or recent use of
             anticoagulant medication that prevents spinal anesthesia, local or systemic infection)

          -  any other reason deemed significant by attending anesthesiologist

          -  any patient requiring a wheelchair for ambulation or who cannot walk 25 feet with or
             without an assist device at time of surgery

          -  presence of neuropathy in posterior thighs or buttocks

          -  use of greater than the equivalent of morphine 25 mg IV (oxycodone 30 mg PO) daily

          -  any patient deemed a poor candidate for spinal anesthesia as determined by the
             attending anesthesiologist