<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03801863</url>
  </required_header>
  <id_info>
    <org_study_id>2018-9687</org_study_id>
    <nct_id>NCT03801863</nct_id>
  </id_info>
  <brief_title>The Use of Lumbar Erector Spinae Plane Block for Hip Arthroplasty at the L4 Interspace</brief_title>
  <official_title>The Use of Lumbar Erector Spinae Plane Block for Hip Arthroplasty at the L4 Interspace- a Randomized Controlled Study Comparing the 24-hour Opioid Requirements.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Montefiore Medical Center</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Montefiore Medical Center</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>Yes</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Over 300,000 hip arthroplasties are performed each year in the United States.1 This number&#xD;
      has been steadily increasing over the last two decades, likely due to increased life&#xD;
      expectancy and, more significantly, the obesity epidemic. Traditionally, this procedure has&#xD;
      been performed under general anesthesia. However, neuraxial and regional anesthesia have&#xD;
      become more commonly utilized to aid in postoperative analgesia. Postoperative pain control&#xD;
      has a significant impact on earlier ambulation, initiation of physical therapy, better&#xD;
      functional recovery, and overall patient satisfaction.2 Moreover; optimal pain management can&#xD;
      reduce the duration of hospitalization and the risk of adverse events, such as deep vein&#xD;
      thrombus. The use of regional anesthesia reduces the postoperative opioid requirement,&#xD;
      thereby decreasing the degree to which patients suffer the side effects of opioids, namely&#xD;
      sedation and constipation, and less frequently nausea, vomiting, respiratory depression,&#xD;
      pruritus, and retention. In the past, femoral nerve block, fascia iliaca compartment block,&#xD;
      lumbar plexus block and the quadratus lumborum block have been shown efficacious for pain&#xD;
      relief for hip arthroplasty. However there are several risk factors such as quadricep&#xD;
      weakness and difficulty of the block that causes a limitation in the used of this blocks.&#xD;
      Recently, the erector spinae plane block has been introduced as an alternative to the blocks&#xD;
      above. This block was first described in the literature in 2016 when it was used to treat&#xD;
      chronic neuropathic thoracic pain. Since then, there have been studies demonstrating its&#xD;
      efficacy with a thoracic approach for analgesia in breast surgery and rib fractures.9 Only&#xD;
      two case reports to date have demonstrated a lumbar approach to achieve analgesia for hip&#xD;
      arthroplasty.10,11 The purpose of the study is to determine whether or not a lumbar erector&#xD;
      spinae plane block is effective at improving postoperative pain in patients receiving hip&#xD;
      arthroplasty.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Hypothesis:&#xD;
&#xD;
      The erector spinae plane block will decrease opioid requirements in patients undergoing hip&#xD;
      arthroplasty as compared to patients that do not receive the block.&#xD;
&#xD;
      Primary Objective:&#xD;
&#xD;
      To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours&#xD;
      postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal&#xD;
      vs. spinal alone.&#xD;
&#xD;
      Secondary Endpoints:&#xD;
&#xD;
      To evaluate the pain scores at discharge from PACU, at 2 hours post PACU discharge, at 24&#xD;
      hours and at 48 hours postoperative; to evaluate the sensory distribution of the block&#xD;
      (T10-L5); to evaluate whether or not patients that receive the block have evidence of&#xD;
      quadricep muscle weakness&#xD;
&#xD;
      Design and methods This is a randomized, prospective study in patients receiving hip&#xD;
      arthroplasty. Patients will be assigned to receive a lumbar erector spinae block versus no&#xD;
      block. There will be no change in the primary anesthetic technique (spinal anesthesia with&#xD;
      sedation) since these patients routinely get spinal anesthesia for hip arthroplasty. Consent&#xD;
      for the study will be obtained in the preoperative area upon arrival for surgery. Patients&#xD;
      will then be randomized into one of the two groups above. One group will receive a lumbar&#xD;
      erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine&#xD;
      before the procedure using ultrasound guidance. The second group will receive no peripheral&#xD;
      nerve block to serve as the control. Patients to receive a nerve block will receive mild&#xD;
      sedation (1-2mg midazolam ± ≤100mcg fentanyl). All patients receiving nerve blocks will have&#xD;
      a printed image of the block thus to confirm proper spread of local anesthetic both cranially&#xD;
      and caudally.&#xD;
&#xD;
      Postoperatively, the PACU nurse will be asked to document pain scores according to the Visual&#xD;
      Analog Scale (VAS) and total dose of opioids given. The distribution of the sensory block and&#xD;
      motor weakness will be documented in the anesthesiologist's PACU discharge note. For patients&#xD;
      that receive the block, the Physical therapist note will be assessed for any report of&#xD;
      quadriceps muscle weakness (i.e., evidence of buckling while walking).&#xD;
&#xD;
      For postoperative data collection, opioid consumption totals and the pain scores at 2 hours&#xD;
      post admission, at 24 hours and 48 hours post-procedure will be collected from the electronic&#xD;
      medical record (EMR) as documented by nurses on the admitting floor. Additionally, the Acute&#xD;
      Pain service, who rounds on all patients that receive nerve blocks, will make a note of the&#xD;
      pain scores of the patient and any residual muscle weakness or decreased sensation at 24- and&#xD;
      48-hours post-procedure. All data will then be extracted from the EMR by the research&#xD;
      assistant.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Terminated</overall_status>
  <why_stopped>
    Study &quot;Administratively closed&quot; by Albert Einstein College of Medicine IRB as approval expired.&#xD;
    PI no longer with institution. IRB approval expiry date used as Primary Completion date and&#xD;
    Study Completion Date. Enrollment total derived from CTMS&#xD;
  </why_stopped>
  <start_date type="Actual">March 1, 2019</start_date>
  <completion_date type="Actual">January 26, 2022</completion_date>
  <primary_completion_date type="Actual">January 26, 2022</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Case-Control</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Opioid Consumption in PACU and 24 hours post surgery</measure>
    <time_frame>24 hours</time_frame>
    <description>To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal vs. spinal alone.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Pain scores at 2 hours post PACU discharge</measure>
    <time_frame>2 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain</time_frame>
    <description>To evaluate the pain scores at 2 hours post PACU discharge</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>To evaluate the sensory distribution of the block (T10-L5).</measure>
    <time_frame>2 hours post-surgery</time_frame>
    <description>Will test for temperature difference using ice cube.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>To evaluate whether or not patients that receive the block have evidence of quadricep muscle weakness</measure>
    <time_frame>30 hours post-surgery</time_frame>
    <description>Will have patient walk and Physical Therapist will assess for buckling of knee or potential falls while ambulating.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pain scores at 24 hours post PACU discharge</measure>
    <time_frame>24 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain</time_frame>
    <description>To evaluate the pain scores at 24 hours post PACU discharge</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pain scores at 48 hours postoperative</measure>
    <time_frame>48 hours post-surgery. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain</time_frame>
    <description>To evaluate the pain scores at 48 hours postoperative.</description>
  </secondary_outcome>
  <number_of_groups>2</number_of_groups>
  <enrollment type="Actual">65</enrollment>
  <condition>Hip Arthropathy</condition>
  <condition>Regional Anesthesia</condition>
  <arm_group>
    <arm_group_label>Ultrasound-guided Erector Spinae Block</arm_group_label>
    <description>Patients will then be randomized into one of the two groups above. One group will receive a lumbar erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine before the procedure using ultrasound guidance. The second group will receive no peripheral nerve block to serve as the control. All patients receiving nerve blocks will have a printed image of the block thus to confirm proper spread of local anesthetic both cranially and caudally.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>No Ultrasound-guided Erector Spinae Block</arm_group_label>
    <description>Patients with no peripheral nerve block to serve as the control.</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375%</intervention_name>
    <description>Ultrasound-guided Erector Spinae Plane Block will be done at L4 interspace. Ropivacaine 0.375% will be used.</description>
    <arm_group_label>Ultrasound-guided Erector Spinae Block</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Ropivacaine</intervention_name>
    <description>Using 0.375% Ropivacaine in the nerve block</description>
    <arm_group_label>Ultrasound-guided Erector Spinae Block</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Patients undergoing primary total hip replacement under neuraxial anesthesia&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients undergoing primary hip arthroplasty&#xD;
&#xD;
          -  American Society of Anesthesiologists (ASA) Category 1, 2, and 3&#xD;
&#xD;
          -  Patients age ≥18 years&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patient refusal&#xD;
&#xD;
          -  Inability to understand and sign consent&#xD;
&#xD;
          -  Infection at the injection site&#xD;
&#xD;
          -  Known allergy or hypersensitivity to ropivacaine or other amide local anesthetics&#xD;
&#xD;
          -  Contraindication or patient refusal to get spinal anesthesia&#xD;
&#xD;
          -  Thrombocytopenia (platelets &lt; 100,000)&#xD;
&#xD;
          -  Coagulopathy (INR &gt; 1.4)&#xD;
&#xD;
          -  Use of anticoagulant drugs that have not been discontinued in an appropriate amount of&#xD;
             time before the surgery&#xD;
&#xD;
          -  ASA Category 4 and 5&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>99 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Iyabo Muse, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Montefiore Medical Center</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Montefiore Medical Center- Wakefield Campus</name>
      <address>
        <city>Bronx</city>
        <state>New York</state>
        <zip>10467</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief. 2015 Feb;(186):1-8.</citation>
    <PMID>25714040</PMID>
  </reference>
  <reference>
    <citation>Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018 Sep;36(3):403-415. doi: 10.1016/j.anclin.2018.04.001. Epub 2018 Jul 11.</citation>
    <PMID>30092937</PMID>
  </reference>
  <reference>
    <citation>Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018 Nov;50:65-68. doi: 10.1016/j.jclinane.2018.06.033. Epub 2018 Jul 2.</citation>
    <PMID>29980005</PMID>
  </reference>
  <reference>
    <citation>Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018 Feb;44:68. doi: 10.1016/j.jclinane.2017.11.006. Epub 2017 Nov 14. No abstract available.</citation>
    <PMID>29149734</PMID>
  </reference>
  <reference>
    <citation>Tulgar S, Selvi O, Senturk O, Ermis MN, Cubuk R, Ozer Z. Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries. J Clin Anesth. 2018 Jun;47:5-6. doi: 10.1016/j.jclinane.2018.02.014. Epub 2018 Mar 6. No abstract available.</citation>
    <PMID>29522966</PMID>
  </reference>
  <reference>
    <citation>Duellman TJ, Gaffigan C, Milbrandt JC, Allan DG. Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty. Orthopedics. 2009 Mar;32(3):167.</citation>
    <PMID>19309064</PMID>
  </reference>
  <verification_date>July 2023</verification_date>
  <study_first_submitted>January 5, 2019</study_first_submitted>
  <study_first_submitted_qc>January 9, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">January 14, 2019</study_first_posted>
  <last_update_submitted>July 19, 2023</last_update_submitted>
  <last_update_submitted_qc>July 19, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">July 21, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Erector Spinae Plane Block</keyword>
  <keyword>Ropivacaine</keyword>
  <keyword>Ultrasound guided nerve block</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Joint Diseases</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Ropivacaine</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03801863
org study id: 2018-9687
nct id: NCT03801863
lead sponsor: 
has dmc: Yes
is fda regulated drug: Yes
is fda regulated device: No
Over 300,000 hip arthroplasties are performed each year in the United States.1 This number
      has been steadily increasing over the last two decades, likely due to increased life
      expectancy and, more significantly, the obesity epidemic. Traditionally, this procedure has
      been performed under general anesthesia. However, neuraxial and regional anesthesia have
      become more commonly utilized to aid in postoperative analgesia. Postoperative pain control
      has a significant impact on earlier ambulation, initiation of physical therapy, better
      functional recovery, and overall patient satisfaction.2 Moreover; optimal pain management can
      reduce the duration of hospitalization and the risk of adverse events, such as deep vein
      thrombus. The use of regional anesthesia reduces the postoperative opioid requirement,
      thereby decreasing the degree to which patients suffer the side effects of opioids, namely
      sedation and constipation, and less frequently nausea, vomiting, respiratory depression,
      pruritus, and retention. In the past, femoral nerve block, fascia iliaca compartment block,
      lumbar plexus block and the quadratus lumborum block have been shown efficacious for pain
      relief for hip arthroplasty. However there are several risk factors such as quadricep
      weakness and difficulty of the block that causes a limitation in the used of this blocks.
      Recently, the erector spinae plane block has been introduced as an alternative to the blocks
      above. This block was first described in the literature in 2016 when it was used to treat
      chronic neuropathic thoracic pain. Since then, there have been studies demonstrating its
      efficacy with a thoracic approach for analgesia in breast surgery and rib fractures.9 Only
      two case reports to date have demonstrated a lumbar approach to achieve analgesia for hip
      arthroplasty.10,11 The purpose of the study is to determine whether or not a lumbar erector
      spinae plane block is effective at improving postoperative pain in patients receiving hip
      arthroplasty.
Hypothesis:

      The erector spinae plane block will decrease opioid requirements in patients undergoing hip
      arthroplasty as compared to patients that do not receive the block.

      Primary Objective:

      To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours
      postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal
      vs. spinal alone.

      Secondary Endpoints:

      To evaluate the pain scores at discharge from PACU, at 2 hours post PACU discharge, at 24
      hours and at 48 hours postoperative; to evaluate the sensory distribution of the block
      (T10-L5); to evaluate whether or not patients that receive the block have evidence of
      quadricep muscle weakness

      Design and methods This is a randomized, prospective study in patients receiving hip
      arthroplasty. Patients will be assigned to receive a lumbar erector spinae block versus no
      block. There will be no change in the primary anesthetic technique (spinal anesthesia with
      sedation) since these patients routinely get spinal anesthesia for hip arthroplasty. Consent
      for the study will be obtained in the preoperative area upon arrival for surgery. Patients
      will then be randomized into one of the two groups above. One group will receive a lumbar
      erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine
      before the procedure using ultrasound guidance. The second group will receive no peripheral
      nerve block to serve as the control. Patients to receive a nerve block will receive mild
      sedation (1-2mg midazolam ± ≤100mcg fentanyl). All patients receiving nerve blocks will have
      a printed image of the block thus to confirm proper spread of local anesthetic both cranially
      and caudally.

      Postoperatively, the PACU nurse will be asked to document pain scores according to the Visual
      Analog Scale (VAS) and total dose of opioids given. The distribution of the sensory block and
      motor weakness will be documented in the anesthesiologist's PACU discharge note. For patients
      that receive the block, the Physical therapist note will be assessed for any report of
      quadriceps muscle weakness (i.e., evidence of buckling while walking).

      For postoperative data collection, opioid consumption totals and the pain scores at 2 hours
      post admission, at 24 hours and 48 hours post-procedure will be collected from the electronic
      medical record (EMR) as documented by nurses on the admitting floor. Additionally, the Acute
      Pain service, who rounds on all patients that receive nerve blocks, will make a note of the
      pain scores of the patient and any residual muscle weakness or decreased sensation at 24- and
      48-hours post-procedure. All data will then be extracted from the EMR by the research
      assistant.
observational model: Case-Control
time perspective: Prospective
measure: Opioid Consumption in PACU and 24 hours post surgery
time frame: 24 hours
description: To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal vs. spinal alone.
measure: Pain scores at 2 hours post PACU discharge
time frame: 2 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain
description: To evaluate the pain scores at 2 hours post PACU discharge
measure: To evaluate the sensory distribution of the block (T10-L5).
time frame: 2 hours post-surgery
description: Will test for temperature difference using ice cube.
measure: To evaluate whether or not patients that receive the block have evidence of quadricep muscle weakness
time frame: 30 hours post-surgery
description: Will have patient walk and Physical Therapist will assess for buckling of knee or potential falls while ambulating.
measure: Pain scores at 24 hours post PACU discharge
time frame: 24 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain
description: To evaluate the pain scores at 24 hours post PACU discharge
measure: Pain scores at 48 hours postoperative
time frame: 48 hours post-surgery. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain
description: To evaluate the pain scores at 48 hours postoperative.
arm group label: Ultrasound-guided Erector Spinae Block
description: Patients will then be randomized into one of the two groups above. One group will receive a lumbar erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine before the procedure using ultrasound guidance. The second group will receive no peripheral nerve block to serve as the control. All patients receiving nerve blocks will have a printed image of the block thus to confirm proper spread of local anesthetic both cranially and caudally.
arm group label: No Ultrasound-guided Erector Spinae Block
description: Patients with no peripheral nerve block to serve as the control.
intervention type: Procedure
intervention name: Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375%
description: Ultrasound-guided Erector Spinae Plane Block will be done at L4 interspace. Ropivacaine 0.375% will be used.
arm group label: Ultrasound-guided Erector Spinae Block
intervention type: Drug
intervention name: Ropivacaine
description: Using 0.375% Ropivacaine in the nerve block
arm group label: Ultrasound-guided Erector Spinae Block
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: 99 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Iyabo Muse, MD
role: Principal Investigator
affiliation: Montefiore Medical Center
facility: 
country: United States
citation: Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief. 2015 Feb;(186):1-8.
PMID: 25714040
citation: Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018 Sep;36(3):403-415. doi: 10.1016/j.anclin.2018.04.001. Epub 2018 Jul 11.
PMID: 30092937
citation: Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018 Nov;50:65-68. doi: 10.1016/j.jclinane.2018.06.033. Epub 2018 Jul 2.
PMID: 29980005
citation: Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018 Feb;44:68. doi: 10.1016/j.jclinane.2017.11.006. Epub 2017 Nov 14. No abstract available.
PMID: 29149734
citation: Tulgar S, Selvi O, Senturk O, Ermis MN, Cubuk R, Ozer Z. Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries. J Clin Anesth. 2018 Jun;47:5-6. doi: 10.1016/j.jclinane.2018.02.014. Epub 2018 Mar 6. No abstract available.
PMID: 29522966
citation: Duellman TJ, Gaffigan C, Milbrandt JC, Allan DG. Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty. Orthopedics. 2009 Mar;32(3):167.
PMID: 19309064
responsible party type: Sponsor
mesh term: Joint Diseases
mesh term: Ropivacaine
sharing ipd: No