The effect of local anaesthetic and adrenaline injection on pain relief after a total hip replacement
| ISRCTN | ISRCTN16846898 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN16846898 |
| Sponsor | Health Service Executive |
| Funder | Health Service Executive |
- Submission date
- 09/02/2026
- Registration date
- 14/04/2026
- Last edited
- 14/04/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Musculoskeletal Diseases
Plain English summary of protocol
Background and study aims
Pain relief medications after a hip replacement can come in different modalities. A particular technique used by surgeons is the use of an injection used during the surgery around the hip joint. This injection is a combination of local anaesthetic with adrenaline. It's use is well-established in total knee replacement. However, it’s role in total hip arthroplasty is not fully understood. This leads to discrepancies in practice between surgeons. To date there have been low quality, small, randomised control trials with conflicting results. Additionally, there has been no established protocol described in these studies for the delivery of the peri-articular injection.
This study will aim to determine the effects of the injection on post relief after a total hip replacement. The injection will be given according to an agreed protocol amongst the surgeons. Pain control will be measured by asking patients questions from the International Paion Outcomes questionnaire. This will be recorded at 2 different time-points; 24 hours and 48 hours after the operation. Additionally, opioid consumption throughout the patients stay in hospital will also be assessed (measuring Morphine Milligram Equivalents) to determine additionally pain relief requirements.
Who can participate?
Patient over 18 years old with osteoarthritis who have been scheduled for total hip arthroplasty.
Patients under 18 years old, patients with cognitive impairment, previous diagnosis of a pain syndrome, patient’s undergoing bilateral total hip arthroplasty or revision total hip arthroplasty will not be able to take part.
What does the study involve?
Patients undergoing total hip arthroplasty under spinal anaesthetic will be randomised into 2 groups; A & B. Group A will receive a periarticular injection which will be administered to the agreed protocol. Group B will not receive the periarticular injection. Patients will be consented on the morning of their surgery and will be provided with a patient information leaflet. Only surgeons who perform posterior approach total hip arthroplasty will be included to minimise confounding factors between patients. Additionally, patients will all be given the standard post-operative analgesia and physio regime.
What are the possible benefits and risks of participating?
The use of local anaesthetic can have rare side effects such as nausea, vomiting, dizziness, headache.
Where is the study run from?
The study is being carried out at the National Orthopaedic Hospital Cappagh in Dublin (Ireland)
When is the study starting and how long is it expected to run for?
Octovber 2025 to April 2026.
Who is funding the study?
The study is funded by Consultant Innovation Funding from the Health Service Executive (Ireland)
Who is the main contact?
Mr James Cashman, Consultant Orthopaedic Surgeon at the National Orthopaedic Hospital Cappagh, james.cashman@gmail.com
Contact information
Principal investigator
National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas
Dublin
D11 EV29
Ireland
| Phone | +353 1 814 0400 |
|---|---|
| james.cashman@gmail.com |
Scientific, Public
National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas
Dublin
D11EV29
Ireland
 ORCID ID |
0000-0002-9136-0399 |
|---|---|
| Phone | +353 1 814 0400 |
| rosscondell@rcsi.com |
Study information
| Primary study design | Interventional |
|---|---|
| Allocation | Randomized controlled trial |
| Masking | Blinded (masking used) |
| Control | Placebo |
| Assignment | Parallel |
| Purpose | Treatment |
| Participant information sheet | 49006 PAI PIL.pdf |
| Scientific title | PANTHER trial: Efficacy of peri-articular injection in total hip replacement for pain relief. a single-centre, double-blinded randomised controlled trial |
| Study acronym | PANTHER |
| Study objectives | |
| Ethics approval(s) |
Approved 24/09/2025, National Orthopaedic Hospital Cappagh Research Ethics Committee (National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas, Dublin, D11EV29, Ireland; +353 1 814 0400; mary.byrne@nohc.ie), ref: NOHC-2025-ETH-MB-CEO-383 |
| Health condition(s) or problem(s) studied | Pain relief for patients undergoing a total hip replacement for osteoarthritis. |
| Intervention | Patients undergoing total hip arthroplasty under spinal anaesthetic were recruited for the study and prospectively randomised into groups; A & B. Treatment allocations were randomised using sealed opaque envelopes. Group A will receive the periarticular injection which will be administered to the agreed protocol by the surgeon during the procedure. The protocol for administrating the periarticular injection is as follows; 50ml anterior to the acetabular cup, 50ml to the psoas compartment and 50ml to the subcutaneous tissues. Group B will not receive the periarticular injection. Patients will be consented on the morning of their surgery and will be provided with a patient information leaflet. Only surgeons who perform posterior approach total hip arthroplasty will be included to minimise confounding factors between patients. Additionally, both groups of patients will all be given the standard post-operative analgesia and physio regime. Both groups of patients will be followed-up until discharge from hospital. |
| Intervention type | Drug |
| Phase | Not Applicable |
| Drug / device / biological / vaccine name(s) | Chirocaine 5mg/ml solution for injection/concentrate for solution for infusion. Chirocaine 7.5mg/ml solution for injection/concentrate for solution for infusion. 0.9% w/v Sodium Chloride Injection BP. Adrenaline (Epinephrine) 1:1,000 Solution for Injection. |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) |
|
| Completion date | 01/05/2026 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 18 Years |
| Upper age limit | 100 Years |
| Sex | All |
| Target sample size at registration | 128 |
| Key inclusion criteria | Patient over 18 years old with osteoarthritis who have been scheduled for total hip arthroplasty |
| Key exclusion criteria | 1. Patients <18 years old 2. Patients with cognitive impairment 3. Previous diagnosis of a pain syndrome 4. Patient’s undergoing bilateral total hip arthroplasty or revision total hip arthroplasty |
| Date of first enrolment | 01/10/2025 |
| Date of final enrolment | 01/04/2026 |
Locations
Countries of recruitment
- Ireland
Study participating centre
Ireland
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Not expected to be made available |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Other files | Consent form | 09/02/2026 | No | No | |
| Participant information sheet | 09/02/2026 | No | Yes |
Additional files
- 49006 PAI PIL.pdf
- Participant information sheet
- 49006 PAI RCT Consent Form.pdf
- Consent form
Editorial Notes
16/02/2026: Trial's existence confirmed by National Orthopaedic Hospital Cappagh Research Ethics Committee.
