Anesthesia For Total Hip Arthroplasty Research Articles

Multimodal Analgesia and Small Opioid Prescriptions are the New Standard in Total Joint Arthroplasty: A Survey of the AAHKS Membership

IntroductionThe purpose of this survey study was to assess the current analgesia and anesthesia practices used by total joint arthroplasty (TJA) surgeon members of the American Association of Hip and Knee Surgeons (AAHKS) as well as identify changes in practice made by AAHKS members over time. MethodsA survey of 37 questions was created and approved by the AAHKS Research Committee. The survey was distributed to all 3,243 practicing adult reconstruction surgeon members of AAHKS in May 2023. Results were compared to a nearly identical survey sent out to all board-certified adult reconstruction surgeon members of AAHKS five years previously in November 2018. ResultsThere were 527 responses (16%) to the survey. Since 2018, the mean number of opioid pills prescribed after TJA has declined significantly from 49 to 32 pills after TKA and from 44 to 18 pills after THA. The use of multimodal analgesics in addition to opioids has also increased over the past five years from 74 to 93%. The most common medications utilized include nonsteroidal anti-inflammatories (98%), acetaminophen (80%), and gabapentinoids (32%). A majority of surgeons (78%) still use a spinal for total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there has been an increase in the number of surgeons using peripheral nerve blocks for TKA from 69% in 2018 to 84% in 2023. The routine use of periarticular injection or local infiltration anesthesia in THA and TKA has also increased over the past 5 years from 80 to 86%. ConclusionSince 2018, there has been increased adoption of multimodal analgesia and anesthesia, and improved consensus regarding the optimal regimen among surveyed arthroplasty surgeon members of AAHKS. The number of opioid pills prescribed after THA and TKA has declined significantly over the past 5 years.

Comparative Efficacy of General and Regional Anesthesia in Total Hip Arthroplasty: A Comprehensive Review

Comparative Efficacy of General and Regional Anesthesia in Total Hip Arthroplasty: A Comprehensive Review

Operative room time comparison between general and spinal anesthesia in total hip arthroplasty: an institutional study.

A relatively high expense with any procedure is total operative time; two components being the time spent anesthetizing the patient and time spent transferring the patient out of the operating room (OR). Both times can be affected by the anesthetic method used. This study compares different operative time intervals for both spinal anesthesia (SA) and general anesthesia (GA), in patients undergoing a primary total hip arthroplasty (THA), to identify the most appropriate and cost-effective anesthetic method. A retrospective chart review was performed at a single institution for primary total hip arthroplasty procedures performed in the year 2019. Primary THAs without complications performed by three orthopedic surgeons were selected. Anesthesia records for 200 patients were used to compare perioperative time intervals; 100 consecutive patients that received SA and 100 consecutive patients that received GA. The time spent transferring the patient out of the operating room was 8min for GA and 5min for SA (p < 0.001). Total operative time for GA was 90min and 87min for SA (p = 0.3330). Total pre-operative time averaged 26min in SA compared to 25min in GA (p = 0.5874). Non-operative total time (all time components of patient interaction excluding surgery start to surgery finish) was significantly shorter in SA with an average of 52 compared to 56 in GA (p = 0.0151). Time to transfer patient out of the OR and total non-operative time was significantly shorter in patients who received spinal anesthesia. These results and the complications of both general and spinal anesthesia should be taken into consideration when anesthetizing patients undergoing primary THA. III.

Comparison of general vs spinal anesthesia for direct anterior approach total hip arthroplasty in elderly patients: a retrospective study

Aim: It remains unclear whether spinal anesthesia is beneficial instead of general anesthesia in total hip arthroplasty (THA) performed via the direct anterior approach (DAA) in elderly patients. The aim of the present research was to investigate the safety and effectiveness of SA in elderly patients underwent DAA-THA. Materials and Methods: We made a retrospective analysis of 166 elderly patients underwent DAA-THA between January 2018 and December 2021. Patients were divided into two groups: general anesthesia (group GA, n=88) and spinal anesthesia (group SA, n=78). We compared the two groups regarding to 90-day readmission rate, amount of bleeding, blood product transfusion, length of hospital stays (LOS), major adverse cardiac events (MACE), postoperative pulmonary complications (PPC), and intensive care unit (ICU) requirement. We also recorded the demographics and procedure data of the two groups. Results: Ninety-day readmission rate, PPC, and ICU requirement in group SA were significantly lower than group GA (p&lt;0.05). There was no statistical difference between the two groups in terms of amount of bleeding, blood product transfusion, MACE, and LOS. Conclusion: Spinal anesthesia in elderly patients underwent DAA-THA may reduce 90-day readmission rate, PPC, and ICU requirement without increasing amount of bleeding, blood product transfusion, MACE, and LOS.

Increased Postoperative Pseudosubluxation after Total Hip Arthroplasty: A Complication Accelerated by the COVID-19 Pandemic

AbstractThe severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) has accelerated the utilization of spinal anesthesia for total hip arthroplasty. Subsequently, an increase in postoperative prosthetic subluxation has been noted at our institution. We report on our experience with this complication in six patients. We also reviewed the literature for similar cases and potential risk factors. This complication may be treated by either closed reduction or watchful waiting. However, no modifications to postoperative protocols are necessary.

Mepivacaine vs Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty at an Ambulatory Surgery Center.

Mepivacaine spinal anesthetic may facilitate more rapid postoperative recovery in joint arthroplasty than bupivacaine. This study compared recovery, pain, and complications between the 2 anesthetics in anterior-approach total hip arthroplasty (THA) at a free-standing ambulatory surgery center (ASC). This retrospective cohort study of 282 consecutive patients with mean age 55.7±8.8 years and body mass index 30.6±5.3 who underwent THA at an ASC from November 2018 to July 2020 compares mepivacaine (n= 141) vs bupivacaine (n= 141) spinal anesthesia, a transition made in March 2019. The main outcomes were length of stay in the postoperative unit (post acute care unit) prior to same-day discharge (SDD), time to controlled void, and ambulation. Secondarily, postoperative pain scores (0-10) with morphine equivalents were required and any postoperative complications were compared. Mepivacaine decreased mean post acute care unit stay (4.0 vs 5.7hours, P < .001), time to void (3.1 vs 4.9hours, P < .001), and ambulation (3.2 vs 4.5hours, P < .001). No patients needed urinary catheterization or overnight stay. Two patients in the bupivacaine group had transient neurologic symptoms, consisting of foot drop and spinal headache, compared to none with mepivacaine (P= .498). Mepivacaine patients had increased postoperative pain at 2hours (1.7 vs 0.9, P < .001), at discharge (1.1 vs 0.5, P= .004), and morphine equivalent doses received (7.8 vs 3.7 mg, P < .001). Mepivacaine spinal anesthesia for anterior-approach THA safely facilitated more rapid SDD from the ASC through decreased times to controlled void and ambulation with only minor increase in pain when compared to bupivacaine. Level III - Retrospective comparative cohort study.

Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques, and Current Literature Review

Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques, and Current Literature Review

The intraoperative hip range of motion in total hip arthroplasty predicts postoperative patient's satisfaction for cutting toenails and putting on sock

BackgroundRestricted hip range of motion (ROM) has been proposed as a useful diagnostic tool for osteoarthritis. The relations between the intraoperative hip ROM under anesthesia in total hip arthroplasty (THA) and recovery of clinical mobility outcomes were unclear. This study evaluated the association between the intraoperative hip ROM under anesthesia in THA and the postoperative recovery of clinical mobility, including cutting toenails and putting on socks after THA. MethodsThe study was performed as a prospective cohort study and included 93 hips in 85 patients who underwent primary anterior-based muscle-sparing THA in the supine position. The hip ROM was evaluated under anesthesia before skin incision and intraoperative stability test. The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) was evaluated. A questionnaire on whether and how patients could cut toenails and putting on socks was assessed. The relationship between hip ROM at intraoperative stability tests and JHEQ moving score, cutting toenails, and putting on socks scores were evaluated statistically. ResultsWe observed a week positive correlation between intraoperative hip ROM and the total of JHEQ mobility score. A moderate positive correlation was observed between external rotation angle with flexion 90°and cutting toenails and putting on socks score oh JHEQ. 94.6% and 96.8% of the patients could cut their toenails and putting on socks by themselves after surgery. The optimum cutoff range for high patient satisfaction for putting on socks and cutting toenails was 110° for flexion and 35°–40° for the external rotation angle in the intraoperative stability test. ConclusionHip ROM during intraoperative stability testing, especially the external rotation angle can predict postoperative outcomes and patient satisfaction for cutting toenails and putting on socks. We suggested that the capsule or capsular ligament release around the hip was increased to provide sufficient ROM without compromising stability.

Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study.

ObjectiveGeneral anaesthesia with tracheal intubation results in sore throat. We evaluated the influence of the two-handed jaw thrust on postoperative sore throat in patients who require tracheal intubation.MethodsIn this prospective, double-blind, single-centre, parallel-arm, and randomised trial, 92 patients who were scheduled for general anaesthesia for total hip arthroplasty were allocated to one of two groups. In the jaw thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at intubation. In the control group (n = 46), conventional intubation with sham jaw thrust was performed. Incidences of airway morbidities including sore throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were compared.ResultsDuring the postoperative 24 hours, the incidence of sore throat (8 [17%] vs. 20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18 [39%]) compared with the control group. The incidence of cough during the postoperative 24 hours was similar between the groups.ConclusionsThe jaw thrust manoeuvre significantly reduced sore throat and hoarseness in patients after general anaesthesia using tracheal intubation.Clinical trial registration: NCT 03568279.

Anesthetic practice and pattern for total hip and knee replacement in Canada: a 5 year cross-sectional study

Purpose: The objective of the study was to examine choice of anesthesia for total hip arthroplasty (THA) and total knee arthroplasty (TKA) in different provinces of Canada over a five-year period.bIn a retrospective, cross-sectional study, national data for patients undergoing THAs and TKAs between 1st April 2011 and 31st March 2016 was examined. The primary outcome was the anesthetic type used in the surgery, which was categorized as general, spinal, combined, or ‘other’. Total number and percentage of surgeries carried out using each anesthetic type were calculated per fiscal year, in non-teaching and TIs, in each Canadian province and territories, exclusive of Québec. Non-parametric statistics (Pearson Chi square tests) were used to compare the choice of anesthetic type by fiscal year and institution type.Results: During the study period, neuraxial anesthesia (NA) was used for 74.7% of all THAs and 80.3% of all TKAs nationwide. In NTIs, 76.2% of THAs and 80.5% of TKAs were carried out with NA. This trend was similar to that within teaching hospitals, where 73.1% of THAs and 80.6% of TKAs were carried out with NA. Interprovincial comparisons demonstrated a greater preference for NA for both THAs and TKAs in majority of the provinces. There were no significant differences in anesthetic choice between teaching and NTIs.Conclusion: Neuraxial anesthesia was the anesthesia of choice for THA and TKA during the entire study period in Canada, both in teaching and non-teaching institutions. During the study period, a majority of provinces showed a trend of increasing use of neuraxial anesthesia for both THA and TKA, with few exceptions.Citation: Pandey M, Johnson K, Siddiqui MA. Anesthetic practice and pattern for total hip and knee replacement in Canada: a 5 year cross-sectional study. Anaesth pain &amp; intensive care 2019;23(3):301-310

Outcomes After Hypotensive Neuraxial Anesthesia in Total Hip Arthroplasty

Outcomes After Hypotensive Neuraxial Anesthesia in Total Hip Arthroplasty

Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty: A Retrospective Cohort Study.

While benefits of regional anesthesia in total hip arthroplasty (THA) are well documented, data describing the incidence of complications related to the use of posterior lumbar plexus blockade for THA remain limited. Our primary aim was to evaluate the incidence of infectious, bleeding, and neurological complications related specifically to the use of continuous posterior lumbar plexus block for elective THA. We reviewed the electronic medical records of all adult patients who underwent elective THA with continuous posterior lumbar plexus blockade between December 1, 2004, and April 30, 2015, using the Mayo Clinic Total Joint Registry. All complications were verified via manual chart review by 2 reviewers. Patient demographics, type of surgery, and complications were analyzed. A total of 9649 patients who underwent 11,395 THA procedures met the inclusion criteria. There were 8686 (76.2%) primary and 2709 (23.8%) revision THAs. There were no block-related infections (0.00%; 95% confidence interval [CI], 0.00%-0.03%) and only 1 block-related hematoma (0.01%; 95% CI, 0.00%-0.05%) in a patient with multiple risk factors for bleeding. There were 60 (0.53%; 95% CI, 0.40%-0.68%) perioperative nerve injuries. Forty-three were in the sciatic distribution (71.67%; incidence, 0.38%). Although there were no documented overt iatrogenic nerve injuries, the posterior lumbar plexus blockade could not be excluded as the potential cause in 9 cases (incidence, 0.08%) based on clinical distribution or electromyographic findings. In our large, single-center cohort study, we report no catheter-related infections, whereas catheter-related hemorrhagic and neurological complications also appear to be rare.

Neuraxial vs General Anaesthesia for Total Hip and Total Knee Arthroplasty

Abstract Background This systematic review evaluated the evidence comparing patient-important outcomes in spinal or epidural vs general anaesthesia for total hip and total knee arthroplasty. Methods MEDLINE, Ovid EMBASE, EBSCO CINAHL, Thomson Reuters Web of Science, and the Cochrane Central Register of Controlled Trials from inception until March 2015 were searched. Eligible randomized controlled trials or prospective comparative studies investigating mortality, major morbidity, and patient-experience outcomes directly comparing neuraxial (spinal or epidural) with general anaesthesia for total hip arthroplasty, total knee arthroplasty, or both were included. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. Meta-analysis was conducted using the random-effects model. Results We included 29 studies involving 10 488 patients. Compared with general anaesthesia, neuraxial anaesthesia significantly reduced length of stay (weighted mean difference −0.40 days; 95% confidence interval −0.76 to −0.03; P+0.03; I2 73%; 12 studies). No statistically significant differences were found between neuraxial and general anaesthesia for mortality, surgical duration, surgical site or chest infections, nerve palsies, postoperative nausea and vomiting, or thromboembolic disease when antithrombotic prophylaxis was used. Subgroup analyses failed to find statistically significant interactions (P>0.05) based on risk of bias, type of surgery, or type of neuraxial anaesthesia. Conclusion Neuraxial anaesthesia for total hip or total knee arthroplasty, or both appears equally effective without increased morbidity when compared with general anaesthesia. There is limited quantitative evidence to suggest that neuraxial anaesthesia is associated with improved perioperative outcomes. Future investigations should compare intermediate and long-term outcome differences to better inform anaesthesiologists, surgeons, and patients on importance of anaesthetic selection.

Factors influencing the choice of anesthetic technique for primary hip and knee arthroplasty.

Despite evidence in the literature, continuing wide variation exists in anesthetic technique for primary joint arthroplasties. Recent evidence suggests that neuraxial anesthesia has advantages over general anesthesia in terms of mortality, major morbidity and healthcare utilization. Yet, despite the proposed benefits, utilization of these two techniques varies greatly across geographical locations, with general anesthesia being most common for total hip arthroplasty (THA) and total knee arthroplasty (TKA) in parts of the world. We uncover some factors that promote or hinder the use of neuraxial anesthesia in THA and TKA. Healthcare professionals should be familiarized with the evidence for neuraxial anesthesia, and unbiased educational material should be developed for patients regarding anesthetic options for THA and TKA in order to promote best practice.

Combined spinal-paravertebral anesthesia in total hip arthroplasty

Optimizing analgesia in total hip arthroplasty contributed to the idea of combined use of spinal and paravertebral anesthesia. the clinical evaluation of combined spinal-paravertebral anesthesia in patients undergoing total hip ar- throplasty. 67 patients were divided into groups: at the first a combined spinal-paravertebral anesthesia (KSPA) was used, the second - a combined spinal-epidural anesthesia (CSEA). The location of the lumbar plexus was determined by ultrasound scan. Spinal component was provided 0.5% ropivacaine solution. In the perioperative period propofol infusionfor sedation was used. After operation infusion of 0.2% ropivacaine solution at a rate of5-6 ml/hour was started through the catheter for 48 hours. The postoperative period was assessed pain intensity on a 10-point visual analog scale (VAS), the needfor analgesics, incidence of complications and patient satisfaction with the quality of anesthesia. The lumbar plexus at the L2-3 level was in 29,9%- immediately after the release ofthe intervertebral holes, in 67.2%- in the psoas major muscle at L4-5 level of 80.1% in the psoas major muscle. In both groups postoperative pain intensity within 48 hours does not exceed 3, VAS scores. The frequency of complications in the postoperative period was against the background of paravertebral blockade of 18.2%, against the backdrop of epidural analgesia - 26 5%. 90.1% ofpatients in the first group and 82.4% ofpatients in the second group were fully satisfied with the chosen method of anesthesia (p> 0.05). Combined spinal-paravertebral block for total hip arthroplasty is an effective and safe method of pain relief.

Spinal anesthesia: the new gold standard for total joint arthroplasty?

The study by Basques et al. is one in a series of studies that have demonstrated that regional anesthesia is more advantageous than general anesthesia for total hip arthroplasty (THA) patients. Previous studies have shown a multitude of advantages including decreased cost, complications, infections and improved pain control. A randomized study comparing 40 patients found that total costs per case were reduced by almost half in the spinal anesthesia group compared to the general anesthesia group. This was a result of both lower cost for anesthesia and lower cost for recovery. In the same study, there were no relevant differences in anesthesia times, and patients who received general anesthesia had higher postoperative pain scores and needed more analgesics than patients in the spinal anesthesia group. Complications are reduced in spinal anesthesia, as a meta-analysis of ten independent trials found a significant decrease in deep vein thrombosis, pulmonary emboli, surgical time, and blood transfusion compared to general anesthesia in THA patients. Another study similarly found a 25% decrease in intraoperative blood loss and 50% reduction of intraoperative transfusion, with 20% lower total transfusion requirements in spinal anesthesia patients. General anesthesia has been associated with higher risk of surgical site infection and perioperative hyperglycemia in comparison to spinal anesthesia.

Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.

Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia. This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications. Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group. Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.

Intrathecal vs intravenous magnesium as an adjuvant to bupivacaine spinal anesthesia for total hip arthroplasty

BackgroundThe aim of this study was to investigate the effect of intravenous infusion vs intrathecal magnesium sulfate during spinal anesthesia on postoperative pain, analgesic consumption, and intraoperative blood loss on patients undergoing total hip arthroplasty surgery.MethodsIn this prospective randomized controlled study, 75 adult patients, ASA physical status I and II scheduled for total hip arthroplasty, were included and randomized into three groups. Patients in Group I (control) received spinal anesthesia with hyperbaric bupivacaine and fentanyl. In Group II (IT Mg), 50 mg of magnesium sulfate was added to bupivacaine and fentanyl. In Group III (IV Mg), after induction of spinal anesthesia as in group I, a bolus dose of i.v. magnesium sulfate 40 mg kg−1 was injected over 10 min, followed by continuous infusion of 15 mg kg−1 h−1 till the end of surgery. Arterial blood pressure, heart rate, electrocardiography, and O2 saturation were continuously monitored. Onset, duration of sensory and motor block, and postoperative pain scores were assessed. Serum magnesium concentrations were checked before induction of anesthesia, immediately after surgery, at 6 h and 24 h after surgery. Total analgesic consumption and intraoperative blood loss were calculated.ResultsThere were no significant differences between the study groups in terms of onset time and maximum sensory level achieved, as well as onset and duration of motor block. Postoperative pain scores and 24 h analgesic consumption were lower in group II and III with insignificant differences between them. Intraoperative blood loss was significantly lower in group III. Postoperative Mg levels were higher in group III, without significant side effects.ConclusionsBoth i.v. infusion and intrathecal injection of Mg sulfate improved postoperative analgesia after total hip replacement. In addition, i.v. infusion of Mg sulfate reduced intraoperative blood loss.

Epidural Lumbar Block or Lumbar Plexus Block Combined with General Anesthesia: Efficacy and Hemodynamic Effects on Total Hip Arthroplasty

Anesthesia for total hip arthroplasty (THA) is a challenge due to the advanced age and associated diseases of patients. The objective of this study was to evaluate whether the efficacy of the nociceptive blockade, secondary hemodynamic effects, difficulty to execute the technique, and influence in intraoperative bleeding of lumbar plexus block combined with general anesthesia is equivalent to epidural lumbar block in patients undergoing THA. Patients with physical status ASA I to III were randomly separated into two groups, Epidural and Lumbar. In the Epidural group, continuous epidural lumbar block with 10 to 15 mL of 0.5% ropivacaine was performed. Patients in the Lumbar group underwent posterior lumbar plexus block with 0.4 mL.kg(-1) of 0.5% ropivacaine. All patients underwent general anesthesia. The difficulty to perform the technique, its efficacy, and secondary hemodynamic effects were evaluated. Forty-one patients were included in this study. The length of time to execute the epidural block was shorter, but the number of attempts to position the needle was similar in both groups. Epidural block was more effective. In the Lumbar group, an increase in diastolic blood pressure and mean arterial pressure (MAP) and in the double product was observed after the incision, and anesthetic consumption was greater. After the blockade, MAP was lower 50, 60, and 70 minutes after the epidural block. Bleeding was similar in both groups. Nociceptive blockade, which was not associated with hemodynamic instability when combined with general anesthesia, was more effective in epidural block. Lumbar plexus block proved to be a useful technique when combined with general anesthesia when epidural block is contraindicated.

Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty

Gabapentin (GPN) is effective in reducing post-operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre-operative administration of gabapentin is more effective than post-operative administration. After REB approval and informed consent, 126 patients were enrolled in a double-blinded, randomized-controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1-2 h pre-operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G2: GPN/Placebo; G3: Placebo/GPN). Patients received gabapentin 600 mg (G2) or placebo (G1 and G3) 2 h before surgery. All patients had spinal anesthesia [15 mg (3cc) of 0.5% hypobaric bupivacaine with 10 microg of fentanyl]. In the post-anesthetic care unit, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). On the ward, patients received acetaminophen 1000 mg p.o. q6h, celecoxib 200 mg p.o. q12h and a morphine PCA device. Patients were interviewed 6 months post-surgery to determine the incidence and severity of chronic post-surgical pain. Mean+/-SD cumulative morphine (mg) consumption (G1=49.4+/-24.8, G2=47.2+/-30.1 and G3=56.1+/-38.2) at 48 h and pain scores at 12, 24, 36 and 48 h post-surgery were not significantly different among the groups [G1 (n=38), G2 (n=38) and G3 (n=38)]. Side effect profiles were similar across groups. Six months after surgery, the number of patients who reported chronic post-surgical pain (G1=10, G2=12 and G3=9) and the severity of the pain (G1=4.2+/-2.9, G2=4.1+/-2.2 and G3=4.9+/-2.2) did not differ significantly among the groups (P>0.05). A single 600 mg dose of gabapentin given pre-operatively or post-operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen.