- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00927368
Comparison of 3 Techniques for Ultrasound-guided Femoral Nerve Catheter Insertion
Comparison Between Ultrasound Guided Femoral Nerve Block Versus Ultrasound Guided Femoral Nerve Block With the Use of Peripheral Nerve Stimulation for Patients Undergoing Total Knee Replacement.
Study Overview
Status
Conditions
Detailed Description
This is a randomized study which will compare three femoral nerve catheter insertion techniques. Subjects will be randomized into one of thee groups, Group 1: ultrasound guided femoral nerve catheter using a stimulation needle and stimulating catheter, .Group 2: ultrasound guided femoral nerve catheter using a stimulation needle, but non-stimulating catheter, or Group 3: ultrasound guided femoral nerve block without stimulation.
- Pain Scores after surgery with be measured using the VAS (Visual Analogue Scale). Subjects will be asked to rate their pain on a scale of 1-10.
- Block Performance time is the time from starting the block (after prepping and draping) until catheter is placed.
- Opioid requirements will be measured as the total amount of opioids (converted to morphine sulfate equivalents) used both during surgery, and during the first 48 hours after surgery.
- Block failure rate will be calculated as the rate of cases that requires repeating the block after surgery.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44195
- Cleveland Clinic
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 to 80 years old at time of surgery.
- Male or female patients undergoing total knee replacement under either general or neuraxial anesthesia (spinal or epidural). Intraoperative, patients will receive spinal anesthetics with 15 mg bupivacaine and 25mcg of fentanyl intrathecally.
Exclusion Criteria:
- Current or recent drug abuse (within past 6 months).
- Pregnancy.
- Patient refuses regional analgesia.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Ultrasound guidance alone
The Tuohy needle was inserted in out-plane approach.
Needle placement was considered adequate when the tip was visualized beneath the fascia iliaca; the catheter was then introduced 5 cm beyond the needle tip.
Electrical stimulation was not used.
|
The Tuohy needle was inserted in out-plane approach.
Needle placement was considered adequate when the tip was visualized beneath the fascia iliaca; the catheter was then introduced 5 cm beyond the needle tip.
Electrical stimulation was not used.
|
ACTIVE_COMPARATOR: Ultrasound guidance needle stimulation
For the ultrasound guidance and needle stimulation arm, the Tuohy needle was positioned with the tip beneath the fascia iliaca under ultrasound guidance.
The needle tip was then adjusted as necessary to obtain a quadriceps muscle response with a stimulating current ≤0.5 mA (2 Hz, pulse width 0.1 msec).
Subsequently, the catheter was threaded 5 cm beyond the needle tip without additional electrical stimulation
|
For the ultrasound guidance and needle stimulation group, the Tuohy needle was positioned with the tip beneath the fascia iliaca under ultrasound guidance.
The needle tip was then adjusted as necessary to obtain a quadriceps muscle response with a stimulating current ≤0.5 mA (2 Hz, pulse width 0.1 msec).
Subsequently, the catheter was threaded 5 cm beyond the needle tip without additional electrical stimulation.
|
ACTIVE_COMPARATOR: Ultrasound guidance+catheter stimulation
For the ultrasound guidance and catheter stimulation group, the Tuohy needle was positioned with the tip beneath the fascia iliaca under ultrasound guidance.
The needle tip was then adjusted as necessary to obtain a quadriceps muscle response with a stimulating current ≤0.5 mA.
At that point, the peripheral nerve stimulator was then disconnected from the stimulating needle and connected to the proximal end of the catheter.
The catheter was then advanced 5 cm past the needle tip.
If the motor response disappeared during catheter advancement, the catheter was withdrawn slightly until the response returned.
Needle orientation and catheter advancement were adjusted as necessary to elicit quadriceps contractions via the catheter with a stimulating current ≤0.5 mA.
|
The Tuohy needle was positioned with the tip beneath the fascia iliaca under ultrasound guidance.
The needle tip was then adjusted as necessary to obtain a quadriceps muscle response with a stimulating current ≤0.5 mA.
At that point, the peripheral nerve stimulator was then disconnected from the stimulating needle and connected to the proximal end of the catheter.
The catheter was then advanced 5 cm past the needle tip.
If the motor response disappeared during catheter advancement, the catheter was withdrawn slightly until the response returned.
Needle orientation and catheter advancement were adjusted as necessary to elicit quadriceps contractions via the catheter with a stimulating current ≤0.5 mA.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time Weighted Average Verbal Response Scale Pain Score
Time Frame: 48 hours after surgery
|
Time weighted average of verbal response scale (VRS) pain score on a scale from 0 (no pain) to 10 (worst pain imaginable). Verbal Response Scale (VRS) pain scores after surgery - which ranged from 0 (no pain) to 10 (maximum intolerable pain) - were assessed every 30 minutes in the recovery area and every 4 hours thereafter up to 48 hours postoperatively. These individual measurements were averaged for each patient using a time-weighted formula. (For a given patient, the observed VRS pain score profile as a function of time was linearly interpolated and integrated using the trapezoidal rule; then, the time-weighted average was calculated as the value of this integral divided by the total monitoring time of 48 hours.). |
48 hours after surgery
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Opioid Consumption
Time Frame: 48 hours after surgery
|
cumulative opioid consumption, where all opioids were converted to IV morphine equivalents
|
48 hours after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Block Performance Time
Time Frame: time elapsed from beginning the block to catheter placement
|
Block performance time, defined as the time from block start until catheter placement.
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time elapsed from beginning the block to catheter placement
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Incremental Cost of Femoral Nerve Blocks
Time Frame: postoperative period when block is used
|
The incremental cost between strategies was calculated as the additional cost of one strategy to the next less costly strategy.
There was no variance in the price because these prices were contracted with the hospital.
The contracted price for a hospital does not change or fluctuate.
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postoperative period when block is used
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- 09-340
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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