The Effect of Periarticular Multi-Drug Regimen on Pain After Partial Hip Replacement

• Visual analogue scale 1day [ Time Frame: Post Op 1 day ] [ Designated as safety issue: No ]

  Patients will be assessed for pain using a visual analogue pain scale (VAS). It is usually a horizontal line, 100 mm in length, anchored by word descriptors at each end; left side end which represents 0 is 'No pain', right side end with 100 is 'Very severe pain'. The patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks.

  To check the severity of pain VAS will be measured at post op 1day.

  
  

• Opioid consumption 1day [ Time Frame: Post Op 1 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. In the case of persistent pain greater than a visual analogue scale (VAS) pain score of 30 mm, an additional 50 μg of fentanyl will be injected intra-venously by nursing staff until the pain was relieved to a level less than a VAS pain score of 30 mm. And sum of delivery from PCA system and additional opioid fom immediately after operation to post op 1daywill be measured.
  
  
• FPB 1day [ Time Frame: Post Op 1 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. And total frequency of patient to push the button of the PCA machine (FPB) fom immediately after operation to post op 1day will be measured.
  
  
• delirium rating scale at admission [ Time Frame: at admission ] [ Designated as safety issue: No ]
  Delirium rating scale wiil be measured to compare with the post op delerium scale at admisssion.
  
  
• Visual Analogue Scale 4day [ Time Frame: Post OP 4day ] [ Designated as safety issue: No ]

  Patients will be assessed for pain using a visual analogue pain scale (VAS). It is usually a horizontal line, 100 mm in length, anchored by word descriptors at each end; left side end which represents 0 is 'No pain', right side end with 100 is 'Very severe pain'. The patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks.

  To check the severity of pain VAS will be measured at post op 4day.

  
  
• Visual Analogue Scale 7day [ Time Frame: Post Op 7day ] [ Designated as safety issue: No ]

  Patients will be assessed for pain using a visual analogue pain scale (VAS). It is usually a horizontal line, 100 mm in length, anchored by word descriptors at each end; left side end which represents 0 is 'No pain', right side end with 100 is 'Very severe pain'. The patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks.

  To check the severity of pain VAS will be measured at post op 7day.

  
  
• Opioid consumption 4day [ Time Frame: Post Op 4 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. In the case of persistent pain greater than a visual analogue scale (VAS) pain score of 30 mm, an additional 50 μg of fentanyl will be injected intra-venously by nursing staff until the pain was relieved to a level less than a VAS pain score of 30 mm. And sum of delivery from PCA system and additional opioid fom post op 1day to post op 4 day will be measured.
  
  
• Opioid consumption 7day [ Time Frame: Post Op 7 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. In the case of persistent pain greater than a visual analogue scale (VAS) pain score of 30 mm, an additional 50 μg of fentanyl will be injected intra-venously by nursing staff until the pain was relieved to a level less than a VAS pain score of 30 mm. And sum of delivery from PCA system and additional opioid fom post op 4day to post op 7 day will be measured.
  
  
• FPB 4day [ Time Frame: Post Op 4 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. And total frequency of patient to push the button of the PCA machine (FPB) fom post op 1day to post op 4 day will be measured.
  
  
• FPB 7day [ Time Frame: Post Op 7 day ] [ Designated as safety issue: No ]
  The patients will be taught to push the button of the PCA system, which delivered a bolus of drug, each time pain occurred. And frequency of patient to push the button of the PCA machine (FPB) fom post op 4day to post op 7day will be measured.
  
  
• delirium rating scale 1day [ Time Frame: Post Op 1day ] [ Designated as safety issue: No ]
  Delirium rating scale wiil be measured to check the incidence and severity of delirium at post-op 1day.
  
  
• delirium rating scale 4day [ Time Frame: Post Op 4day ] [ Designated as safety issue: No ]
  Delirium rating scale wiil be measured to check the incidence and severity of delirium at post-op 4day.
  
  
• delirium rating scale 7day [ Time Frame: Post Op 7day ] [ Designated as safety issue: No ]
  Delirium rating scale wiil be measured to check the incidence and severity of delirium at post-op 7day.
  
  

Patients in group I will receive oxycodone SR 10 mg, and celecoxib 200 mg with 10 ml of water 1 hour before surgery.

And patients in group I will receive periarticular injection of 50 ml solution which contains ropivacaine 15 mg, epinephrine 0.3 mg, cefmetazole 1000mg, ketorolac 30 mg and morphine HCL 10mg before closure of surgical wound.

Patients in group C will receive no medication.