Study Comparing Regional Anesthetic Blocks and Periarticular Infiltration for the Management of Post-operative Pain After Direct Anterior Total Hip Arthroplasty

Study Overview
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Brief Summary
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To compare two methods of post-operative pain management in patients undergoing total hip arthroplasty. There is a perception that the periarticular injections may not be as effective in controlling post-operative pain. Both methods are current standard of care. The investigators want to compare the outcomes of each when patients are randomized to one of the methods compared to the other method of post-operative pain control.

Official Title
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Prospective Randomized Study Comparing Regional Anesthetic Blocks and Periarticular Infiltration for the Management of Post-operative Pain After Direct Anterior Total Hip Replacement

Conditions
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Degenerative Joint Disease

Intervention / Treatment
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* Other: L2 paravertebral block
* Other: periarticular injection group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject scheduled for Direct Anterior unilateral total hip replacement Weight ≥ 50 and ≤125 kg Intact neurological exam Cognitively intact with ability to sign consent Exclusion Criteria: Renal insufficiency with creatinine > 1.5 mg/dl Allergic to any of the following : Ropivacaine, Epinephrine, Ketorolac, Morphine sulfate, NSAIDs, Tylenol, Neurontin, Morphine, Oxycodone or Dilaudid. Subject taking regular narcotic medications prior to surgery (20mg/day Morphine equivalents for >7days) Subject with prior open hip surgery who received regional anesthesia or periarticular injection for post op pain management. Subject with contraindication for spinal anesthesia

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: L2 paravertebral block<br>regional anesthetic nerve blocks using an L2 paravertebral block with ropivacaine | Other: L2 paravertebral block<br>* nerve block group will receive preoperatively a L2 paravertebral block with indwelling catheter<br>|
| Active Comparator: periarticular injection group<br>periarticular local injection into the periarticular soft tissues at the time of hip replacement using a combination of ropivacaine, epinephrine, ketorolac and morphine sulphate (periarticular injection group). | Other: periarticular injection group<br>* periarticular injection group will receive the injection cocktail towards the end of the total hip replacement prior to skin closure.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in pain score | Static and dynamic post-operative pain scores, measured on a 1 - 10 visual analogue scale. | post-operative to 7 days |