Psoas Compartment Block Versus Periarticular Local Anesthetic for Total Hip Arthroplasty

Study Overview
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Brief Summary
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The primary objective of this study is to examine whether there is a difference in the level of resting pain following total hip arthroplasty with an anterior approach with use of a psoas compartment block versus a local periarticular anesthetic infiltration

Detailed Description
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A single-center, prospective, randomized clinical trial with a total of 100 patients. One orthopaedic adult reconstruction surgeon at Beaumont Hospital Royal Oak (JJV) will perform all surgeries. After the patient has consented they will be randomized to one of the following two groups: Psoas compartment block (n=50) Periarticular local anesthetic infiltration (n=50), The patient will be blinded to the study group.

Official Title
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Psoas Compartment Block Versus Periarticular Local Anesthetic Infiltration for Pain Management for Total Hip Arthroplasty: A Prospective, Randomized Study

Conditions
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Osteoarthritis, Arthroplasty

Intervention / Treatment
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* Drug: Ropivacaine with NaCl
* Drug: Epinephrine
* Drug: Morphine
* Drug: Ketorolac Tromethamine
* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing unilateral primary total hip arthroplasty by Dr. James Verner at Beaumont Hospital Royal Oak Have a diagnosis of primary osteoarthritis (i.e. degenerative joint disease) Surgical approach is anterior Exclusion Criteria: Minors (age less than 18 years) Pregnant (surgically sterile, post-menopausal, or negative blood test) Previous ipsilateral hip surgery Lumbar instrumentation Acute trauma Rheumatoid arthritis Avascular necrosis Hip dysplasia Known sensitivity, allergy, or contraindication to anesthetics being used in the study Narcotic sensitivity History of over 6 months of opioid dependency prior to surgery (excluding tramadol) Peripheral neuropathy Mental/cognitive impairment that would interfere with the patient's self-assessments of function, pain, or quality of life

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Psoas Compartment Block<br>After exposure anesthetic (Ropivacaine with NaCl) is introduced directly into the iliopsoas muscle, where it then spreads to the lumbar plexus (the nerves responsible for sensation around the surgical site). | Drug: Ropivacaine with NaCl<br>* 50 mL (40 mL of 0.2% Ropivicaine and 10 mL of 0.9% NaCl) are administered into the psoas compartment<br>* Other names: Naropin with NaCl;|
| Active Comparator: Periarticular Local Anesthetic<br>An anesthetic cocktail of four drugs (ropivacaine, epinephrine, ketorolac tromethamine, morphine) is injected at five locations at the surgical site to the surrounding tissues. | Drug: Epinephrine<br>* 0.15 mg Epinephrine are injected as part of the drug cocktail<br>* Other names: adrenaline;Drug: Morphine<br>* 4 mg Morphine are injected as part of the drug cocktail<br>Drug: Ketorolac Tromethamine<br>* 30 mg morphine are injected as part of the drug cocktail<br>* Other names: Toradol;Drug: Ropivacaine<br>* 30 mL 0.5% Ropivicaine are injected as part of the drug cocktail<br>* Other names: Naropin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Score at 3 Hours | Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain | 3 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Score at 3-24 Hours | Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain | measured once during time frame 3 hours-24 hours postoperative | 
| Pain Score at 24-48 Hours | Visual Analog Scale 0-10; 0 = no pain, 10 = worst pain | measured once during time froma 24-48 hours postoperative | 
| Opioid Usage In-hospital at 24 Hours | Total amount of opioids used per patient (measured with Morphine Equivalent Units) | 24 hours postoperatively | 
| Opioid Usage In-hospital at 48 Hours | Total amount of opioids used per patient (measured with Morphine Equivalent Units) | 48 hours postoperatively |