After total joint replacement, early hospital discharge to home (with patients capable of continuing a home-based rehabilitation program) is a cost- effective management strategy. This project will use improved local anesthetic nerve block techniques to enhance technical capability and clinical practice by (i) reducing pain and other morbidities during recovery, (ii) improving weight-bearing achievement during in-hospital physical therapy to allow for earlier return home, and (iii) continued rehabilitation as an outpatient at home when feasible (versus in an extended care facility).
Patients will have spinal anesthesia for their hip or knee replacement surgery. They will also receive the nerve blocks described above
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
98
Nerve blocks before surgery of L2-L4 and L4-S3 for Knee replacements Nerve blocks before surgery of L2-L4 for hip replacements
Nerve blocks before surgery of L2-L4 and L4-S3 for Knee replacements Nerve blocks before surgery of L2-L4 for hip replacements
VA Pittsburgh Healthcare System
Pittsburgh, Pennsylvania, United States
Short-Form McGill Pain Questionnaire (Version 2) Total Score Difference From Baseline
SF-MPQ version 2 total score difference of Post-Operative Day 1 value minus the Baseline value. Differences can range from -10 to +10. Negative scores indicate a decrease in pain.
Time frame: Baseline, Post-Operative day after surgery (7AM-9AM EST)
SF-MPQ2 Continuous Pain Subscore Difference From Baseline
Continuous pain subscore difference of Post-Operative Day 1 value minus the Baseline value. Differences can range from -10 to +10. Negative scores indicate a decrease in pain.
Time frame: Baseline, Post-Operative day after surgery (7AM-9AM EST)
SF-MPQ2 Intermittent Pain Subscore Difference From Baseline
Intermittent pain subscore difference of Post-Operative Day 1 value minus the Baseline value. Differences can range from -10 to +10. Negative scores indicate a decrease in pain.
Time frame: Baseline, Post-Operative day after surgery (7AM-9AM EST)
Quality of Recovery 15 Item Scale (QoR-15) Total Score
Quality of Recovery 15 Item Scale, total score 0-150, 150 reflecting a perfect score and better recovery.
Time frame: Day after surgery (7AM-9AM EST)
Quality of Recovery 15 Item Scale (QoR-15) Total Score
Quality of Recovery 15 Item Scale, total score 0-150, 150 reflecting a perfect score and better recovery.
Time frame: 6 weeks post-operation
Performed-based Physical Function is Assessed Using the Standing Balance Test.
The Standing Balance Test score based on the ability of the participant to perform a series of standing exercises. Scores range from 0 to 4, with 4 indicating a longer time holding the stand (a better outcome). This test is germane to subjects with total joint replacement that are easily performed in the clinical settings. The test will capture the domains of muscle strength and activation, and balance.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 6 weeks post-operation
Performed-based Physical Function is Assessed Using the Self-Selected Gait Speed Test.
The Self-Selected Gait Speed Test is a timed test based on the ability of the participant to walk a 4 meter distance. This test is germane to subjects with total joint replacement that are easily performed in the clinical settings. The test captures the ability to walk.
Time frame: 6 weeks post-operation
Performed-based Physical Function is Assessed Using the Repeated Chair Stand Test.
The Repeated Chair Stand Test is a timed test based on the ability of the participant to perform a series of standing exercises. This test is germane to subjects with total joint replacement that are easily performed in the clinical settings. The test will capture the domains of muscle strength and activation, and balance.
Time frame: 6 weeks post-operation