Nausea in Patients Receiving Hydromorphone vs Oxycodone After Total Hip Replacement Surgery

Nausea and vomiting in the post-operative period is considered strongly undesirable by patients and has adverse effects on recovery from outpatient procedures, contributing significantly to delays in discharge from recovery. A know major contributor to the occurrence of post-operative nausea and vomiting is the use of opiate medications which are the cornerstone of post-operative pain management. The investigators hypothesize that the occurrence of this side-effect is different between patients prescribed oxycodone and those receiving hydromorphone for acute pain management after total hip replacement surgery. This investigation is a randomized, double-blind, head-to-head comparison to equipotent administration of oxycodone vs. hydromorphone to determine whether such a difference exists.

Patients will be prescribed oxycodone 10mg (5mg if > age 65) every 2 hours as needed for post-operative pain management in addition to tylenol 1000mg every 6 hours and celecoxib 200mg every 12 hours.

Patients will be prescribed hydromorphone 2mg (1mg if > age 65) every 2 hours as needed in addition to tylenol 1000mg every 6 hours and celecoxib 200mg every 12 hours.

Patients will receive oxycodone 10mg (5mg if > 65) every 2 hours based on an equianalgesic dose calculation. As per routine practice, the dose will be titrated according to the patient's pain at the discretion of the Acute Pain Service physician who will not be blinded to group allocation.

Patients will receive an initial dose of hydromorphone 2mg (1mg if > 65) every 2 hours as needed based on an equianalgesic dose calculation. As per routine practice, the dose will be titrated according to the patient's pain at the discretion of the Acute Pain Service physician who will not be blinded to group allocation.

The presence or absence of the opioid related side effects will be recorded twice daily until 72 hours post-operatively

Total in-hospital opioid consumption in morphine equivalent doses will be calculated for the first 72 hours post-operatively

The number of administrations and doses of anti-nausea medications will be evaluated until 72 hours post-operatively

The cumulative drug cost based on all anti-nausea and analgesic medications administered will be calculated for the first 72 hours post-operatively

The number of post-operative days required for admission will be assessed. Duration is to be an expected average of 72 hours

Inclusion Criteria: American Society of Anesthesiologists Physical Status Classification System 1-3 Age 18-85 years Patients undergoing hip replacement surgery under spinal anesthesia Exclusion Criteria: patient refusal contraindication or refusal of spinal anesthesia inability to provide informed consent history of dementia intolerance or allergy to oxycodone or hydromorphone chronic opioid use or chronic pain disorder pregnancy history of drug addiction history of major psychiatric illness

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