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The goal of this retrospective chart review is to evaluate if the implementation of lumbar plexus block placement for postoperative pain have improved conditions in the postoperative period for patients undergoing total hip arthroplasty when compared to the placement of epidurals for postoperative pain management.
Primary outcome: 48 hour opiate consumption in patients following THA. ' Secondary outcome: Time to first ambulation, assistance needed with ambulation, opiate and regional related side effects, time to discharge orders.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lumbar plexus | Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management. | ||
| Lumbar Epidural | Patients received a lumbar epidural preoperatively for postoperative pain management. Epidural infusions of ropivacaine 0.2% were initiated intraoperatively, administered until the morning of postoperative day 1, and titrated to patient comfort. |
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| Measure | Description | Time Frame |
|---|---|---|
| Opiate Consumption | Cumulative opiate consumption in intravenous (IV) morphine mg equivalents (MME) | 48 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Time of First Ambulation | Time of first ambulation relative to anesthesia end time (hours) | 48 hours |
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Inclusion Criteria:
18 years and older
Diagnosis of:
Perioperative multimodal medication
Hospitalized from July 1, 2012 to December 17, 2014.
Exclusion Criteria:
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The study team will identify subject by the Primary Diagnosis of THA, (identified by CPT code 27130) and 2) either a) Epidural (CPT code 62319) or b) Lumbar plexus peripheral nerve block (CPT 62311 or 64449) with the administration of multimodal medication.
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| Name | Affiliation | Role |
|---|---|---|
| Sylvia Wilson, MD | Medical University of South Carolina | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University of South Carolina | Charleston | South Carolina | 29425 | United States |
Subjects meeting inclusion criteria were assigned a chronological number based on the date of their operation (Epidural 1-342; Lumbar plexus 1-107) and then randomized using Microsoft Excel. Data were collected on the first 58 randomized subjects in each group; 58 epidural patients and 58 lumbar plexus patients.
Inclusion criteria included primary, elective THA with either lumbar epidural (n=547) or lumbar plexus peripheral nerve block (n=219) for postoperative analgesia. Exclusion criteria included THA revision, traumatic fractures, non-elective surgeries, and postoperative ICU admission. 342 epidural &107 lumbar plexus patients met inclusion criteria.
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| ID | Title | Description |
|---|---|---|
| FG000 | Lumbar Plexus | Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management. |
| FG001 | Lumbar Epidural | Patients received a lumbar epidural preoperatively for postoperative pain management. Epidural infusions of ropivacaine 0.2% were initiated intraoperatively, administered until the morning of postoperative day 1, and titrated to patient comfort. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Lumbar Plexus | Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management. |
| BG001 | Lumbar Epidural | Patients received a lumbar epidural preoperatively for postoperative pain management. Epidural infusions of ropivacaine 0.2% were initiated intraoperatively, administered until the morning of postoperative day 1, and titrated to patient comfort. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Opiate Consumption | Cumulative opiate consumption in intravenous (IV) morphine mg equivalents (MME) | Posted | Mean | Standard Error | Opiate Consumption (IV MME) | 48 hours postoperative |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Lumbar Plexus | Patients received a preoperative lumbar plexus nerve block (20 ml, ropivacaine 0.5%) for postoperative pain management. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Sylvia Wilson | MUSC | 8437922322 | wilsosh@musc.edu |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units | Counts |
|---|---|
| Participants |
|
|
| Secondary | Time of First Ambulation | Time of first ambulation relative to anesthesia end time (hours) | Posted | Mean | Standard Error | Hours | 48 hours |
|
|
|
| 0 |
| 58 |
| 0 |
| 58 |
| 0 |
| 58 |
| EG001 | Lumbar Epidural | Patients received a lumbar epidural preoperatively for postoperative pain management. Epidural infusions of ropivacaine 0.2% were initiated intraoperatively, administered until the morning of postoperative day 1, and titrated to patient comfort. | 0 | 58 | 0 | 58 | 0 | 58 |
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| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |