- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01556724
A Comparison of Postoperative Analgesic Nerve Block Ropivacaine Concentrations
A Comparison of 0.1 and 0.2% Ropivacaine in Lumbar Plexus Catheters After Primary Total Hip Arthroplasty: a Comparison of Postoperative Analgesia and Motor Function.
Peripheral nerve blocks are the standard of care for pain management after hip replacement surgery at UPMC Shadyside. This prospective, randomized study is intended to assess the effect of 0.1 versus 0.2% ropivacaine in lumbar plexus nerve catheter infusions after total hip arthroplasty. Ropivacaine peripheral nerve block infusions have been utilized as the standard of care at UPMC Shadyside for many years. Ropivacaine, a less potent left-isomer of bupivacaine, is often used in place of bupivacaine due to less motor blockade and less severe cardiovascular and central nervous system potential toxicity.
The primary goal of this study to examine the effect of a low concentration infusion of ropivacaine (0.1%) on postoperative analgesia (evaluated by opioid consumption after 36 hours) compared with the standard accepted concentration of 0.2% ropivacaine in lumbar plexus catheters after primary total hip arthroplasty. Secondary goals are to examine motor function, VAS scores and patient satisfaction with pain control in low concentration 0.1% ropivacaine compared with 0.2% ropivacaine lumbar plexus infusions upto 36 hours after primary total hip arthroplasty.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15232
- UPMC Presbyterian Shadyside
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18-75 years old
- American Society of Anesthesiologists physical status score I-III
- Scheduled for primary total hip arthroplasty at UPMC Shadyside Hospital in Pittsburgh, PA.
- No contraindications to peripheral nerve catheter placement
- Patients not expected to receive therapeutic anticoagulation in the postoperative period.
- No known drug allergies to study medications
- Patients willing to receive spinal anesthesia as operative anesthetic
Exclusion Criteria:
- Age under 18 years or older than 75 years.
- Any contraindication to a placement of continuous lumbar plexus peripheral nerve catheter.
- American Society of Anesthesiologist physical status IV or greater.
- Chronic painful conditions.
- Preoperative opioid tolerant use (opioid use for greater than 6 contiguous months before surgery).
- Coagulation abnormalities or patients who are expected to be on therapeutic anticoagulants postoperatively.
- Allergy to any of the drugs/agents used study protocol.
- Pregnancy
- Having an altered mental status (not oriented to place, person, or time)
- Any comorbid condition that, in the judgment of the consulting orthopedic surgeon or intraoperative anesthesiologist, would proscribe the patient from any aspect of the study.
- Patient refusal.
- Patient requiring postoperative management in the ICU
- Lumbar plexus catheter placed by loss of resistance technique.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 0.2% ropivacaine nerve block (standard of care)
0.2% ropivacaine in lumbar plexus nerve catheter infusions for postoperative analgesia
|
Either 0.1% or 0.2% ropivacaine will be infused at 7 mL/hr through lumbar plexus nerve block catheter based upon randomization, and can then receive a 6 ml bolus of either 0.1% or 0.2% ropivacaine.
Additional pain relief will be available by nurse administered boluses of additional local anesthetic (from their randomized infusion) with a maximum dose of an extra 3 ml per bolus and limited to one bolus per hour.
This bolus of their randomized local anesthetic will remain available until the nerve catheters are removed.
Nerve block infusion rates may be increased to 9 ml/h for patients with increased pain without increased motor blockade as determined by the acute interventional perioperative pain service (AIPPS) or decreased to 5 ml/h for patients with increased motor blockade or weakness from the peripheral nerve block as determined by the AIPPS .All continuous lumbar plexus catheters will be removed on post operative day (POD) 2.
Other Names:
|
Experimental: 0.1% ropivacaine infusion in nerve block catheter
0.1% ropivacaine in lumbar plexus nerve catheter infusions
|
Either 0.1% or 0.2% ropivacaine will be infused at 7 mL/hr through lumbar plexus nerve block catheter based upon randomization, and can then receive a 6 ml bolus of either 0.1% or 0.2% ropivacaine.
Additional pain relief will be available by nurse administered boluses of additional local anesthetic (from their randomized infusion) with a maximum dose of an extra 3 ml per bolus and limited to one bolus per hour.
This bolus of their randomized local anesthetic will remain available until the nerve catheters are removed.
Nerve block infusion rates may be increased to 9 ml/h for patients with increased pain without increased motor blockade as determined by the acute interventional perioperative pain service (AIPPS) or decreased to 5 ml/h for patients with increased motor blockade or weakness from the peripheral nerve block as determined by the AIPPS .All continuous lumbar plexus catheters will be removed on post operative day (POD) 2.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opiate Consumption Postoperatively
Time Frame: 24 hours postoperatively
|
Postoperative opiate consumption at 24 hours
|
24 hours postoperatively
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Satisfaction With Pain Control
Time Frame: 24 hours postoperatively
|
Patient satisfaction with pain control at 24 hours (0-10 scale).
Patients' satisfaction was assessed using an 11-point numeric scale (0-10, 0 = unsatisfied and 10 = very satisfied).
Scores at 24 hours were not averaged with any other scores.
|
24 hours postoperatively
|
Numeric Rating Scale Pain Score With Movement at 24 Hours
Time Frame: 24 hours postoperatively
|
Numeric rating scale (NRS) pain score with movement were assessed at 24 hours.
Pain scores were followed using an 11-point NRS (0 = no pain and 10 = worst imaginable pain).
Scores at 24 hours were not averaged with any other scores.
|
24 hours postoperatively
|
Number of Participants With Increased Infusion Rates
Time Frame: Subjects will be followed postoperatively until postoperative day 2 (i.e. the discontinuation of the lumbar plexus catheters)
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Number of patients requiring increased infusion rates to 9 mL/hour to better optimize pain control.
|
Subjects will be followed postoperatively until postoperative day 2 (i.e. the discontinuation of the lumbar plexus catheters)
|
Number of Participants With Decreased Infusion Rates
Time Frame: Subjects will be followed postoperatively until postoperative day 2 (i.e. the discontinuation of the lumbar plexus catheters)
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Number of patient requiring decreased infusion rates decreased to 5 mL/hour due to increased motor blockade.
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Subjects will be followed postoperatively until postoperative day 2 (i.e. the discontinuation of the lumbar plexus catheters)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sylvia Wilson, MD, University of Pittsburgh Medical Center
- Study Chair: Jacques E Chelly, MD, PhD, MBA, University of Pittsburgh Medical Center
Publications and helpful links
General Publications
- Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008 Aug;79(2):92-105.
- Marino J, Russo J, Kenny M, Herenstein R, Livote E, Chelly JE. Continuous lumbar plexus block for postoperative pain control after total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009 Jan;91(1):29-37. doi: 10.2106/JBJS.H.00079.
- Siddiqui ZI, Cepeda MS, Denman W, Schumann R, Carr DB. Continuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2007 Sep-Oct;32(5):393-8. doi: 10.1016/j.rapm.2007.04.008.
- de Leeuw MA, Dertinger JA, Hulshoff L, Hoeksema M, Perez RS, Zuurmond WW, de Lange JJ. The efficacy of levobupivacaine, ropivacaine, and bupivacaine for combined psoas compartment-sciatic nerve block in patients undergoing total hip arthroplasty. Pain Pract. 2008 Jul-Aug;8(4):241-7. doi: 10.1111/j.1533-2500.2008.00209.x. Epub 2008 May 23.
- Zink W, Graf BM. Local anesthetic myotoxicity. Reg Anesth Pain Med. 2004 Jul-Aug;29(4):333-40. doi: 10.1016/j.rapm.2004.02.008.
- Paauwe JJ, Thomassen BJ, Weterings J, van Rossum E, Ausems ME. Femoral nerve block using ropivacaine 0.025%, 0.05% and 0.1%: effects on the rehabilitation programme following total knee arthroplasty: a pilot study. Anaesthesia. 2008 Sep;63(9):948-53. doi: 10.1111/j.1365-2044.2008.05538.x. Epub 2008 Jun 6.
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRO09090339
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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