Randomized, Controlled Trial Comparing the Effectiveness of Sedation-Epidural Anesthesia to Spinal Anesthesia in Outpatient Hip or Knee Arthroplasty.

Participation Requirements

• Sex:

  ALL

• Eligible Ages:

  18 to 80

Participation Criteria

Inclusion Criteria:

* Patient has symptomatic hip or knee OA requiring primary joint replacement (not associated with unusual treatments such as bone graft, concomitant osteotomy, revision implant, etc.).
* Patient who is candidate for our ERAS program
* Patient understands the study condition
* Patient capable of giving informed consent.
* Someone to accompany the patient to the Pre-admission Clinic and hospital the day of the surgery and to be available in the first postoperative week during home recovery.

Exclusion Criteria:

* Patients with contraindication to NA (spinal anatomical abnormalities, coagulation disorders, infection at the puncture site)
* Allergy to LAs used in the study
* Unable to communicate with the investigators, unable to read the questionnaire, unable to keep track and notes of the medication taken at home
* Lack of home services offered by the local community service centre in the area.
* BMI \> 40.
* Psychiatric disease limiting participation or interfering with the ability to provide consent or assessment
* Need for long-term urinary Foley catheter post-op.
* Allergies to sulfonamides or other medications specified in the protocol.
* Cognitive impairment or communication problem
* Pulmonary embolism or deep vein thrombosis in the past year.
* Need for long-term anticoagulation therapy.
* Current corticotherapy or systemic corticotherapy in the past year (unless confirmation of a cortrosyn test prior to surgery).
* Systemic disease involvement (diabetes, heart, kidney, blood, etc.) necessitating special perioperative care (intensive care, multiple transfusions, dialysis, etc.).
* Coagulation disorder increasing the risk of intraoperative and postoperative bleeding including thrombocytopenia (platelet count lower than 80), hemophilia, prolonged INR (1,4 and over) and any order coagulation disorder deemed a contra-indication to neuraxial anesthesia..
* Locomotor problem, other than the joint to be replaced, imposing functional limitations that prevent movement without technical or physical assistance.
* Neurological or balance disorder.
* Living space incompatible with home care.
* Clcr \< 30 ml/min (Cockcroft-Gault formula).
* Pregnancy