Femoral Versus Psoas Continuous Peripheral Nerve Blocks Following Hip Arthroplasty

Study Overview
=================
Brief Summary
-----------------
The purpose of this research study is to determine if the insertion site of a perineural catheter, or tiny tube placed next to the nerves that go to the hip which you will have surgery, affects the amount of pain relief that is experienced after surgery.

Detailed Description
-----------------
To determine the association between perineural catheter location and postoperative analgesia, analgesic requirements, ambulatory distance, and flexion following hip arthroplasty. Primary Hypothesis: Differing the catheter insertion site (femoral vs. psoas compartment) for a perineural local anesthetic infusion is not associated with lower pain scores during the 24-hour period beginning the morning following hip arthroplasty.

Official Title
-----------------
Femoral Versus Psoas Continuous Peripheral Nerve Blocks Following Hip Arthroplasty

Conditions
-----------------
Hip Arthroplasty, Hip Pain

Intervention / Treatment
-----------------
* Procedure: Femoral Nerve Block vs. Psoas Compartment Nerve Block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: primary, unilateral hip arthroplasty or hip resurfacing age greater than or equal to 18 years postoperative analgesic plan includes perineural local anesthetic infusion Exclusion Criteria: morbid obesity (BMI greater than 40) chronic, high-dose opioid use history of opioid abuse pregnancy incarceration amu meirp-muscular deficit of the ipsilateral femoral nerve and/or quadriceps muscle inability to communicate with hospital staff

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1. Femoral Nerve Block<br>Patients will be randomized with a computer program to receive a femoral catheter. The catheter will be placed using standard technique. The time of catheter placement will be recorded as well as the pain/discomfort of catheter placement as reported by the patient on a 0-10 scale where 0=no pain/discomfort and 10=worst imaginable pain/discomfort. | Procedure: Femoral Nerve Block vs. Psoas Compartment Nerve Block<br>* Patients, undergoing hip arthroplasty or hip resurfacing will be randomized to one of two groups: femoral nerve block or psoas compartment nerve block. Patients randomized to femoral nerve block will receive this block prior to surgery. Patients randomized to psoas compartment nerve block will receive this block prior to surgery. Both patients will receive Mepivicaine via catheter prior to surgery and following surgery, Ropivicaine via pain pump.<br>|
| Active Comparator: 2. Psoas Compartment Catheter<br>Patients will be randomized with a computer program to receive a psoas compartment catheter. The catheter will be placed using standard technique. The time of catheter placement will be recorded as well as the pain/discomfort of catheter placement as reported by the patient on a 0-10 scale where 0=no pain/discomfort and 10=worst imaginable pain/discomfort. | Procedure: Femoral Nerve Block vs. Psoas Compartment Nerve Block<br>* Patients, undergoing hip arthroplasty or hip resurfacing will be randomized to one of two groups: femoral nerve block or psoas compartment nerve block. Patients randomized to femoral nerve block will receive this block prior to surgery. Patients randomized to psoas compartment nerve block will receive this block prior to surgery. Both patients will receive Mepivicaine via catheter prior to surgery and following surgery, Ropivicaine via pain pump.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient's mean pain score (NRS) during perineural infusion as measured by the nursing staff at UCSD and entered in the computer system. |  | 24 hours beginning 7:30am day following surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesic used, as reported by nursing staff in the UCSD computer system. |  | 3 days following surgery | 
| Patient's ambulation distance as recorded by therapist (occupational or physical) in the UCSD computer system. |  | 3 days following surgery | 
| Hip flexion, in degrees measured with a standard goneometer, as recorded by therapist (occupational or physical) in the UCSD computer system. |  | 3 days following surgery | 
| Infusion duration of pain pump, measured on the pump itself in hours and minutes. |  | 3 days following surgery | 
| Duration of hospital stay, in hours, as reported in the UCSD computer system. |  | 3 days following surgery | 
| Surgical/anesthetic adverse events as reported by hospital staff |  | day of surgery and 3 days following | 
| Experiences of patient during the infusion and following, as reported to study staff in a phone conversation, one week following surgery. |  | 1 week following surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
pain, Hip Resurfacing, catheter, nerve block, UCSD, hip surgery, psoas, femoral, ambulation, hip flexion, infusion