Multimodal Analgesic Regimen for Total Hip Arthroplasty: An Initiative to Minimize Postoperative Opioid Use
22 juin 2026 mis à jour par: Michael Charters, MD, Henry Ford Health System
This study examines whether patients undergoing total hip replacement surgery can manage their pain effectively while using fewer opioid pain medications.
Participants will be randomly assigned to one of two groups.
The first group will receive the standard postoperative pain medication regimen, with all prescriptions sent directly to their pharmacy as usual.
The second group will receive the same medications, but their opioid prescription will only be provided as a printed copy rather than being sent directly to the pharmacy, requiring them to choose whether to fill it.
All participants will keep a pain journal and complete questionnaires about their medication intake over the first 21 days post-op as well as there function and wellbeing at follow up visits over 3 months.
The goal is to determine whether this approach reduces opioid use while still adequately controlling pain after hip replacement surgery.
Aperçu de l'étude
Statut
Pas encore de recrutement
Les conditions
Type d'étude
Interventionnel
Inscription (Estimé)
100
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Coordonnées de l'étude
- Nom: Antonio M Pellerito, BA
- Numéro de téléphone: 586-859-3258
- E-mail: ampeller@umich.edu
Lieux d'étude
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Michigan
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Detroit, Michigan, États-Unis, 48202
- Henry Ford Hospital
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Contact:
- Antonio Pellerito, BA
- Numéro de téléphone: 586-859-3258
- E-mail: ampeller@umich.edu
-
-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Non
La description
Inclusion Criteria:
- Adult patients age 18 and older
- Patients who have undergone total hip arthroplasty by a single, fellowship trained Orthopaedic Surgeon.
Exclusion Criteria:
- Patients with incomplete data in medical records
- Chronic opioid use in the last 3 months
- Ipsilateral joint surgery in the last year
- Cannot tolerate oral medications
- Swallowing difficulties
- Intolerance to Tylenol, Celebrex, Robaxin, Neurontin, or Tramadol
- History of Alcohol abuse
- History of Drug abuse
- History of Renal impairment
- History of Peptic ulcer disease
- History of GI bleeding
- Illicit narcotic usage in past 6 months
- Chronic liver disease
- Chronic pain syndrome
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Comparateur actif: Standard Postoperative Pain Protocol (Control)
Participants receive the standard postoperative multimodal pain regimen following primary total hip arthroplasty.
All prescriptions, including opioids, are sent directly to the patient's pharmacy per usual care.
Participants complete a postoperative pain journal, medication log, respond to phone/text check-ins regarding pain scores, and complete PROMIS, HOOS Jr., and Harris Hip Score questionnaires at follow-up visits postoperatively.
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Participants receive the standard postoperative multimodal pain regimen following primary total hip arthroplasty.
All prescriptions are sent directly to the patient's pharmacy.
Opioid consumption tracked via the Michigan Automated Prescription System (MAPS) and patient medication journal.
Pain and medication consumption are assessed via daily pain/medication logs daily for the first week, then weekly for two additional weeks.
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|
Expérimental: Opioid-Reduced Postoperative Pain Protocol (Treatment)
Participants receive the standard postoperative multimodal pain regimen following primary total hip arthroplasty.
Opioid prescriptions (Tramadol) are printed and given to the patient rather than sent directly to the pharmacy, requiring the patient to drive to the pharmacy if they choose to fill them.
Participants complete a postoperative pain journal, mediation logs, respond to phone/text check-ins, and complete PROMIS, HOOS Jr., and Harris Hip Score questionnaires at follow-up visits postoperatively.
|
Participants receive the standard postoperative multimodal pain regimen following primary total hip arthroplasty.
Tramadol is prescribed but the prescription is printed and given to the patient rather than sent to the pharmacy, requiring the patient to actively choose to fill it.
This behavioral barrier is designed to reduce opioid consumption while preserving patient autonomy.
Pain and medication intake is assessed via daily pain journals and medication logs for the first week, then weekly for two additional weeks.
Opioid consumption is also tracked via the Michigan Automated Prescription System (MAPS).
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Postoperative Pain Score (Visual Analog Scale)
Délai: Preoperative baseline through 3 weeks postoperatively
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Pain severity measured using a visual analog scale (VAS) scored 0-10, where 0 represents no pain and 10 represents the worst possible pain.
Scores collected preoperatively, daily during inpatient admission, daily for the first week post-discharge, then weekly for 2 additional weeks via patient pain journal and phone/text check-ins.
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Preoperative baseline through 3 weeks postoperatively
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Postoperative Nausea Score (Visual Analog Scale)
Délai: Preoperative baseline through 3 weeks postoperatively
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Nausea severity measured using a visual analog scale (VAS) scored 0-10, where 0 represents no nausea and 10 represents the worst possible nausea.
Scores collected preoperatively, daily during inpatient admission, daily for the first week post-discharge, then weekly for 2 additional weeks via patient pain journal and phone/text check-ins.
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Preoperative baseline through 3 weeks postoperatively
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Opioid Consumption
Délai: Three weeks post-op
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Total opioid consumption measured in morphine milligram equivalents (MME) and by dose and quantity.
Inpatient opioid use collected via electronic medical record and the Michigan Automated Prescription System (MAPS).
Post-discharge opioid use recorded by the patient in a postoperative pain journal.
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Three weeks post-op
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Antiemetic Consumption
Délai: three weeks postoperatively
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Total antiemetic consumption recorded by dose and quantity.
Inpatient use collected via electronic medical record; post-discharge use recorded by the patient in a postoperative pain journal.
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three weeks postoperatively
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Length of Hospital Stay
Délai: Perioperative/Periprocedural
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Total number of days from surgical admission to hospital discharge following primary total hip arthroplasty.
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Perioperative/Periprocedural
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Episodes of Nausea
Délai: Three weeks postoperatively
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Number of nausea episodes documented.
Inpatient episodes collected via electronic medical record; post-discharge episodes recorded by the patient in a postoperative pain journal.
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Three weeks postoperatively
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.)
Délai: Up to three months postoperatively
|
Patient-reported outcome measure assessing hip pain and function specific to joint replacement patients.
Scored on a 0-100 scale, with higher scores indicating better hip function.
Administered at scheduled postoperative follow-up visits.
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Up to three months postoperatively
|
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Harris Hip Score
Délai: Up to three months postoperatively
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Clinician-administered outcome measure assessing hip pain, function, absence of deformity, and range of motion following total hip arthroplasty.
Scored on a scale of 0 to 100, where higher scores indicate better hip function and outcomes.
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Up to three months postoperatively
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PROMIS Physical Function
Délai: Up to three months postoperatively
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Patient-reported outcome measure assessing self-reported capability to perform physical activities.
Administered via the PROMIS Physical Function item bank at scheduled postoperative follow-up visits.
Scores are reported as T-scores with a mean of 50 and standard deviation of 10 in the general population, where higher scores indicate better physical function.
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Up to three months postoperatively
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Timed Up and Go Test (TUG)
Délai: Prior to hospital discharge, assessed up to 2 weeks postoperatively
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Functional mobility test measuring the time in seconds for a patient to rise from a chair, walk 3 meters, turn, walk back, and sit down.
Administered by physical therapy prior to hospital discharge
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Prior to hospital discharge, assessed up to 2 weeks postoperatively
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Range of Motion (ROM)
Délai: up to three months postoperatively
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Hip range of motion measured in degrees at postoperative follow-up visits by the treating surgeon or clinical staff.
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up to three months postoperatively
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Distance Walked During Physical Therapy Sessions
Délai: Up to three months postoperatively
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Total distance walked in feet or meters recorded by physical therapy during inpatient physical therapy sessions following surgery.
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Up to three months postoperatively
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Surgical Site Infection
Délai: Up to three months postoperatively
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Occurrence of superficial or deep surgical site infection at the operative site following primary total hip arthroplasty, identified during clinical follow-up visits or by chart review.
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Up to three months postoperatively
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Acute Prosthetic Joint Infection
Délai: Up to three months postoperatively
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Occurrence of acute periprosthetic joint infection following primary total hip arthroplasty, identified during clinical follow-up visits or by chart review per standard clinical criteria.
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Up to three months postoperatively
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Wound Dehiscence
Délai: Up to three months postoperatively
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Occurrence of wound dehiscence at the surgical site following primary total hip arthroplasty, identified during clinical follow-up visits or by chart review.
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Up to three months postoperatively
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PROMIS Pain Interference
Délai: Up to three months postoperatively
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Patient-reported outcome measure assessing the degree to which pain interferes with daily activities and social participation.
Administered via the PROMIS Pain Interference item bank at scheduled postoperative follow-up visits.
Scores are reported as T-scores with a mean of 50 and standard deviation of 10 in the general population, where higher scores indicate greater pain interference.
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Up to three months postoperatively
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PROMIS Emotional Distress: Depression
Délai: Up to three months postoperatively
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Patient-reported outcome measure assessing depressive symptoms including helplessness, hopelessness, and emotional exhaustion.
Administered via the PROMIS Emotional Distress.
Depression item bank at scheduled postoperative follow-up visits.
Scores are reported as T-scores with a mean of 50 and standard deviation of 10 in the general population, where higher scores indicate greater emotional distress.
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Up to three months postoperatively
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Les enquêteurs
- Chercheur principal: Michael Charters, MD, Henry Ford Health System
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Beakley BD, Kaye AM, Kaye AD. Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician. 2015 Jul-Aug;18(4):395-400.
- Scully RE, Schoenfeld AJ, Jiang W, Lipsitz S, Chaudhary MA, Learn PA, Koehlmoos T, Haider AH, Nguyen LL. Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures. JAMA Surg. 2018 Jan 1;153(1):37-43. doi: 10.1001/jamasurg.2017.3132.
- Cho CH, Song KS, Min BW, Lee KJ, Ha E, Lee YC, Lee YK. Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2011 Oct;19(10):1744-8. doi: 10.1007/s00167-010-1294-y. Epub 2010 Oct 19.
- Fiore JF Jr, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, Figueiredo AG, Valanci S, Marquez-GdeV JA, Schulz M, Moldoveanu D, Nguyen-Powanda P, Best G, Banks A, Landry T, Pecorelli N, Baldini G, Feldman LS. Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia. Br J Anaesth. 2019 Nov;123(5):627-636. doi: 10.1016/j.bja.2019.08.014. Epub 2019 Sep 25.
- Fiore JF Jr, El-Kefraoui C, Chay MA, Nguyen-Powanda P, Do U, Olleik G, Rajabiyazdi F, Kouyoumdjian A, Derksen A, Landry T, Amar-Zifkin A, Bergeron A, Ramanakumar AV, Martel M, Lee L, Baldini G, Feldman LS. Opioid versus opioid-free analgesia after surgical discharge: a systematic review and meta-analysis of randomised trials. Lancet. 2022 Jun 18;399(10343):2280-2293. doi: 10.1016/S0140-6736(22)00582-7.
- Chia PA, Cannesson M, Bui CCM. Opioid free anesthesia: feasible? Curr Opin Anaesthesiol. 2020 Aug;33(4):512-517. doi: 10.1097/ACO.0000000000000878.
- Moutzouros V, Jildeh TR, Khalil LS, Schwartz K, Hasan L, Matar RN, Okoroha KR. A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids? Arthroscopy. 2020 Aug;36(8):2249-2257. doi: 10.1016/j.arthro.2020.04.018. Epub 2020 Apr 28.
- Pirkle S, Reddy S, Bhattacharjee S, Shi LL, Lee MJ. Chronic Opioid Use Is Associated With Surgical Site Infection After Lumbar Fusion. Spine (Phila Pa 1976). 2020 Jun 15;45(12):837-842. doi: 10.1097/BRS.0000000000003405.
- Bravo L, Mico JA, Berrocoso E. Discovery and development of tramadol for the treatment of pain. Expert Opin Drug Discov. 2017 Dec;12(12):1281-1291. doi: 10.1080/17460441.2017.1377697. Epub 2017 Sep 17.
- Goldman AH, Griffis CE, Johnson DD, Balazs GC. Shifts in Prescribers' Initial Postoperative Opioid Prescriptions Following Primary Total Hip Arthroplasty Between 2014 and 2018. J Arthroplasty. 2020 Nov;35(11):3208-3213. doi: 10.1016/j.arth.2020.06.002. Epub 2020 Jun 10.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude (Estimé)
1 juin 2026
Achèvement primaire (Estimé)
1 décembre 2026
Achèvement de l'étude (Estimé)
30 mai 2027
Dates d'inscription aux études
Première soumission
5 juin 2026
Première soumission répondant aux critères de contrôle qualité
22 juin 2026
Première publication (Réel)
29 juin 2026
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
29 juin 2026
Dernière mise à jour soumise répondant aux critères de contrôle qualité
22 juin 2026
Dernière vérification
1 juin 2026
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 14751-27
Plan pour les données individuelles des participants (IPD)
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NON
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
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Étudie un produit d'appareil réglementé par la FDA américaine
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