Hip Arthropathy Clinical Trial
Official title:
Randomized Controlled Trial Study in Hip Arthroplasty by Direct Anterior Approach Using Opioid Free Anesthesia (OFA) Versus Standard Opioid Anesthesia.
all patients with a first anterior arthroplasty, give their informed consent to be randomized
to control or study protocol.
control means no high steroid dose, opioids for anesthesia; paracetamol, NSAIDs and opioids
as analgesia.
study protocol means methylprednisolone 125 mg and opioid free anesthesia followed by
paracetamol, NSAIDs and if needed opioids as escape.
study group means for Anesthesia:
1. High dose corticoids pre-operative: 125 mg Methylprednisolone. (Medrol) pre incision and
24h postoperative
2. OFA using a multimodal approach including alpha2agonists, lidocaine and low dose
ketamine (max 1mg/kg).
3. Avoid opioids post-operative by using multimodal non-opioid analgesics after OFA. Avoid
epidural to allow rapid mobilization.
all patients get Tranexamic acid 1 g (2 amp Exacyl 500mg) before and 1 g after surgery. It
act as antifibrinolytic to reduce postoperative bleeding. (reversibly binding to lysine
receptor sites on plasminogen) Try to give Continuous deep neuromuscular block (NMB) with a
post titanic count (PTC) < 3 by continuous infusion and monitoring of NMB.
Intravenous Fluid restrictions to 1 ml/kg/h as long as pulse pressure (or plethysmograph)
variation < 20% to reduce wound edema.
The pericapsular injections of local anesthetic, provided the patient had no
contraindications such as poor renal function or allergies. 100 ml Ropivacaine 0,2% (max dose
3 mg/kg) + additives (Adrenaline 2,5 cc) (Ropivacaine: max 3 mg/kg)
;
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