Spinal Anesthesia in Total Hip Arthroplasty

Study Overview
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Brief Summary
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Spinal anesthesia is commonly used in patients undergoing total hip replacements. The purpose of this study is to compare lidocaine to bupivacaine spinal anesthesia in patients having a total hip arthroplasty (THA). The objective of this study is to compare the two spinal anesthesia treatments in regards to transient neurological symptoms (TNS).

Detailed Description
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Most surgeons would agree total hip arthroplasty (THA) is one of the most successful surgical interventions. However, when it comes to the type of anesthesia to improve THA outcomes, surgeons do not agree. General anesthesia has been shown to be associated with increases in adverse events, increased operating room times and increased length of stay. Therefore, more surgeons are turning to spinal anesthesia for better pain control, decreased need for narcotics resulting in less nausea, sooner recovery of bowel function, and faster participation in physical therapy. All of these factors can lead to a sooner discharge from the hospital, which would lead to significant cost savings. Transient neurological symptoms (TNS) are a concern of using spinal anesthesia and have been shown to occur up to 16-40% of the time with lidocaine. Symptoms of TNS have been described as pain, dysesthesia, or both that occur in the legs or buttocks and urinary retention after recovery from spinal anesthesia. Intensity of pain varies but can be quite severe. Symptoms can appear in a few hours, for up to 24 hours after surgery. Lidocaine is the most widely used anesthetic due to its rapid onset, intense nerve blockade, and short duration of action. The risk of developing TNS after spinal anesthesia with lidocaine has been shown to be higher when compared to other anesthetics. However, it is unknown whether there are differences between patients who undergo spinal anesthesia with lidocaine versus bupivacaine in THA. This knowledge is important because it has been shown that bupivacaine spinal anesthesia is more effective than lidocaine with minimal adverse effects. A large randomized, prospective study is needed to prove the difference between the two types of anesthesia. The primary objective of this study is to compare TNS among people who receive one of two spinal anesthesia treatments, lidocaine or bupivacaine. The study will be conducted on individuals who are indicated for THA and have agreed to have spinal anesthesia during their surgery. All patients will be randomized by a computer program and will receive either lidocaine or bupivacaine spinal anesthesia prior to their THA. In addition to TNS, other outcomes include urinary retention, hypotension, ambulation and length of hospital stay.

Official Title
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Comparison of Lidocaine Versus Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty: A Randomized, Double-Blind, Prospective Study

Conditions
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Total Hip Arthroplasty

Intervention / Treatment
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* Drug: Lidocaine
* Drug: Bupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Radiographic evidence of symptomatic osteoarthritis in one or bilateral hips. Osteoarthritis will be defined as pain with weight-bearing at the hip articulation together with radiographic findings Indicated for total hip arthroplasty Agreement to undergo spinal anesthesia for surgery Exclusion Criteria: Patient refusal to undergo spinal anesthesia Patients with a known history of lumbar or sacral spinal fusion. Patients with a known history of prostate, urological, or kidney surgery. Patients who need monitoring of urine output during surgery (including patients with confirmed renal disease, renal failure, chronic renal insufficiency, or an indwelling catheter at the time of surgery). Current infection at site of injection Women of child-bearing potential who are on Medicare (child-bearing potential will be determined prior to surgery per Anesthesia standard of care) Hypovolemia Indeterminate neurologic disease Allergy or hypersensitivity to the study medications Currently taking any anti-coagulation medications or coagulopathic Increased intracranial pressure Subject is unable to make his/her own decision regarding the informed consent Subject is unable to read/understand English

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Lidocaine prior to THA<br>Participants scheduled for Total Hip Arthroplasty through anterior approach with Lidocaine spinal anesthesia and completing telephone questionnaires to see how they are feeling post-operation. | Drug: Lidocaine<br>* Spinal anesthesia administered prior to participant's THA<br>|
| Active Comparator: Bupivacaine prior to THA<br>Participants scheduled for Total Hip Arthroplasty through anterior approach with Bupivacaine spinal anesthesia and completing telephone questionnaires to see how they are feeling post-operation. | Drug: Bupivacaine<br>* Spinal anesthesia administered prior to participant's THA<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Transient Neurological Symptoms (TNS) on Day 1 Post-Operation | Following a prepared questionnaire, a study team member asked about TNS and pain that was not associated with the operation area. The count of participants reporting any type of TNS is presented here. | Day 1 (day of surgery) Post-Operation | 
| Post-Operative Transient Neurological Symptoms Score on Day 1 Post-Operation | Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area. Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort. | Day 1 (day of surgery) Post-Operation | 
| Number of Participants With Transient Neurological Symptoms on Post-Operative Day 7 | Following a prepared questionnaire, a study team member asked about TNS and pain that was not associated with the operation area. The count of participants reporting any type of TNS is presented here. | Post-Operative Day 7 | 
| Transient Neurological Symptoms Score on Post-Operative Day 7 | Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area. Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort. | Post-Operative Day 7 | 
| Number of Participants With Transient Neurological Symptoms on Post-Operative Day 14 | Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain not associated with the operation area. The count of participants reporting any type of TNS is presented here. | Post-Operative Day 14 | 
| Transient Neurological Symptoms Score on Post-Operative Day 14 | Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area. Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort. | Post-Operative Day 14 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Voiding Without Complications After Recovery From Spinal Anesthesia | Urine retention after recovery from spinal anesthesia was assessed as the count of participants voiding without complications. Data were obtained through review of the inpatient records. | Day 1 (day of surgery) Post-Operation | 
| Time to Ambulation After Recovery From Spinal Anesthesia | Time to ambulation after recovery from spinal anesthesia is assessed in minutes. Information about time to full ambulation was obtained by asking participants or from inpatient medical charts. | Day 1 (day of surgery) Post-Operation | 
| Count of Participants With Hypotension | The number of participants experiencing hypotension, defined as systolic blood pressure of <90 mmHg, is presented here. Blood pressure information was obtained from reviewing the inpatient medical charts. | Day 1 (day of surgery) Post-Operation | 
| Number of Participants Discharged 0, 1, or 2 Days Following Surgery | Hospital length of stay was obtained from inpatient charts. Length of stay was determined using the hospital admission dates and discharge dates, and was then categorized as being discharged the same day as the surgery, the day after surgery, or two days after surgery. | Up to Post-Operative Day 2 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total hip arthroplasty, Anterior total hip replacement, Transient neurological symptoms, Hip replacement, Spinal anesthesia