A Clinical Trial of Two Periarticular Multimodal Drug Injections in Total Hip and Knee Arthroplasty
A Clinical Trial of Two Periarticular Multimodal Drug Injections in Total Hip and Knee Arthroplasty
This study evaluates two routinely used drug combinations for periarticular injection
 following total hip and knee arthroplasty for pain control. One group will receive liposomal
 bupivacaine, bupivacaine, clonidine, epinephrine and ketorolac. The other group will receive
 ropivacaine, clonidine, epinephrine and ketorolac.
A key component of the multimodal approach to pain management is the intra-operative surgical
 site injection of a local anesthetic or drug cocktail. There are many formulations used for
 this purpose. A formulation documented in the literature was implemented by this institution
 which has dropped the average length of stay dramatically. Concern over the limited half-life
 of the administered anesthetic and the continued need for opioid administration has led to a
 search for better drug formulations and administration vehicles. Recently, the FDA approval
 of an extended release bupivacaine called liposomal bupivacaine was thought to extend the
 effective half-life of the anesthetic agent and thereby prolong post-operative anesthesia.
 Use of liposomal bupivacaine in total joint surgery was almost universally adopted after its
 recent approval and has been an integral part of the "same day total joint" movement.

 Studies have suggested improvement in pain control and shortened hospitalizations with the
 use of liposomal bupivacaine. Other studies have raised questions about the effectiveness of
 this agent. Recently a randomized double blind study was performed with total knees which
 demonstrated no improvement in pain management with the addition of liposomal bupivacaine to
 the multimodal pain management protocol. This study has not been performed in the hip
 arthroplasty population.
Inclusion Criteria:

 -  Hip Arthritis (osteoarthritis, post traumatic, inflammatory, and avascular necrosis)

 Exclusion Criteria:

 -  Current use of opioid drugs

 -  Revision surgery

 -  Surgical complication (femoral fracture with implant insertion)

 -  Inability to provide Informed Consent