Analgesia After Total Knee Arthroplasty: Peri-Articular Injection Versus Epidural + Femoral Nerve Blockade
Condition: Readiness to Discharge
Intervention: Peri-Articular Injection; Epidural Pathway (PCEA+FNB)
Intervention description: Pre-operative anesthesia/analgesia: meloxicam (7.5 or 15mg), dexamethasone (6mg) Anesthetic:: Combined Spinal-Epidural with 0.5% bupivacaine. IV sedation with midazolam, propofol Antiemetic: 20mg famotidine, 4mg ondansetron Postoperative pain management: hydromorphone/bupivacaine PCEA (4/4/10/20, initially). Meloxicam (7.5 or 15mg), Oxycodone/Acetaminophen (5/325 3hr PRN); Pre-operative anesthesia/analgesia: meloxicam (7.5 or 15mg), extended release oxycodone (10mg or 20mg), dexamethasone (6mg), clonidine patch (100 mcg/24 hr) Anesthetic: Spinal with 0.5% bupivacaine, IV sedation with midazolam, propofol Antiemetic: 20mg famotidine, 4mg ondansetron Post-operative analgesia:Prilosec (20mg), Meloxicam (7.5mg or 15 mg PO), extended release oxycodone (10mg or 20mg), Oxycodone (5mg q 3 hr PRN), Acetaminophen (1000mg), ketorolac 15mg IV
Phase: Phase 4
Study type: Interventional
Primary purpose: Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Enrollment: 91.0
Sex: All
Minimum age: 18 Years
Maximum age: 85 Years
Healthy volunteers: No

Summary:

      There are 2 common ways to manage pain after total knee arthroplasty at our institution. Some
      patients receive an epidural analgesia, a femoral nerve block and pills for pain. More
      recently, some surgeons have replaced femoral nerve blockade with peri-articular injections.
      These patients receive a peri-articular injection (injection of pain medication around the
      knee), pills for pain and a pain patch on the skin. The purpose of this research project is
      to find out if one of these ways to treat pain is better than the other. The investigators
      will look at this question in many ways, but the main way is how long it takes for you to be
      judged ready for discharge from the hospital.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients with osteoarthritis scheduled for primary bicompartmental total knee
             arthroplasty with a participating surgeon

          -  Age 18 to 85 years old

          -  Planned use of regional anesthesia

          -  Ability to follow study protocol

          -  Up to 15 degrees varus, up to 15 degrees flexion and up to 15 degrees valgus

        Exclusion Criteria:

          -  Patients younger than 18 years old and older than 85

          -  Patients intending to receive general anesthesia

          -  Allergy or intolerance to one of the study medications

          -  Patients with an ASA of IV

          -  Patients with insulin-dependent diabetes

          -  Patients with hepatic (liver) failure

          -  Patients with chronic renal (kidney) failure

          -  Chronic opioid use (taking opioids for longer than 3 months)

          -  Patients with any prior major ipsilateral open knee surgery.

          -  Patients with flexion contracture of knee > 15 degrees

          -  Patients with varus deformity > 15 degrees

          -  Patients with valgus deformity > 15 degrees

          -  Patients with a contraindication to use of epinephrine