Liposomal Bupivacaine Versus Standard Analgesia in Total Joint Arthroplasty (TJA)

August 30, 2016 updated by: Deborah Napier, OhioHealth

Efficacy of Liposomal Bupivacaine Versus Standard Analgesia in Pain Management of Total Joint Arthroplasty

The purpose of this study is to determine whether liposomal bupivacaine is effective in the management of pain following total joint arthroplasty, as compared to standard of care analgesia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Liposomal bupivacaine (Exparel®) is a local anesthetic made up of liposomal encapsulated bupivacaine. It is designed to be injected at the time of surgery into the local soft tissues. Because of its unique liposomal delivery system, Liposomal bupivacaine (Exparel®) has been shown to provide up to 96 hours of pain relief following surgeries. This makes it an attractive option in total joint arthroplasty patients. Combined with the proven efficacy of regional anesthesia, intraoperative liposomal bupivacaine (Exparel®) may provide extended pain relief following total joint arthroplasty. This has the potential to avoid the need for opioid medications. With better pain control, medication side effects can be avoided and patient's length of stay in the hospital can be shortened.

Study Type

Interventional

Enrollment (Actual)

211

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Ohio
      • Columbus, Ohio, United States, 43214
        • OhioHealth Riverside Methodist Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Clinical diagnosis of osteoarthritis
  2. Elected to undergo primary TKA, THA, or TSA

Exclusion Criteria:

  1. Age < 18 years
  2. Pregnant or breastfeeding
  3. Non-English speaking
  4. Unable to give informed consent
  5. Previous open hip, knee or shoulder surgery
  6. Pre-determined patients discharging to ECF
  7. Patients with allergies to bupivacaine
  8. Patients currently taking opioid pain medication
  9. Patients with contraindication to nerve blocks
  10. Patients undergoing simultaneous bilateral joint replacement, as this would require >1 dose of liposomal bupivacaine (Exparel®) per patient for each surgical site
  11. Patients with severe hepatic disease
  12. Patients with chronic heart disease as defined as a decreased ejection fraction

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Standard of care analgesia

Total Hip Arthroplasty (THA):

All patients will receive a spinal anesthetic using Fentanyl and Bupivacaine

Injection into capsular tissue after placement of the acetabular component:

0.5% Bupivacaine 15 cc 40 mg Solumedrol 10 mg Morphine 20 cc Saline

Total Knee Arthroplasty (TKA):

All patients will receive a spinal anesthetic using Fentanyl and Bupivacaine All patients will receive an adductor canal block of 0.25% Bupivacaine w/epinephrine 30cc

Injection into posterior capsule of the knee:

0.5% Bupivacaine 15 cc 40 mg Solumedrol 10 mg Morphine 20 cc Saline

Total Shoulder Arthroplasty (TSA):

All patients will receive a standard interscalene block with bupivacaine followed by indwelling catheter insertion with ropivacaine infusion to be left in place for two days.
Drug: Standard of care analgesia
Other Names:
  • Saline
  • Bupivacaine
  • Solumedrol
  • Ropivacaine
  • Fentanyl
  • Epinephrine
  • Morphine
Experimental: Liposomal bupivacaine

THA:

Standard of care analgesia, PLUS 266 mg of liposomal bupivacaine. Anterior capsule Inferior capsule Posterior capsule Short external rotator Gluteus maximus Subcutaneous tissue

TKA:

Standard of care analgesia, PLUS 266 mg of liposomal bupivacaine. Posterior knee capsule Anterior femoral periosteum Anterior tibial periosteum Subcutaneous tissue Pericapsular meniscal tissue

TSA:

All patients will receive a standard interscalene block with bupivacaine PLUS 266 mg of liposomal bupivacaine.

Posterior capsule Rotator cuff Subscapularis Humeral periosteum Subcutaneous tissue Deltopectoral muscle
Drug: Liposomal bupivacaine
Other Names:
  • Exparel
Drug: Standard of care analgesia
Other Names:
  • Saline
  • Bupivacaine
  • Solumedrol
  • Ropivacaine
  • Fentanyl
  • Epinephrine
  • Morphine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Length of Stay in Hospital (Days)
Time Frame: Participants were followed for the duration of hospital stay, an expected average of 3 days
Participants were followed for the duration of hospital stay, an expected average of 3 days

Secondary Outcome Measures

Outcome Measure
Time Frame
Time to Post-operative Rescue Opioids (Hours)
Time Frame: Immediately following discharge from operating room until the participant was discharged from the hospital, an expected average of 3 days
Immediately following discharge from operating room until the participant was discharged from the hospital, an expected average of 3 days
Readmission or Emergency Department (ED) Visit Due to Pain Control Within 30 Days
Time Frame: Date of discharge through 30 days following discharge
Date of discharge through 30 days following discharge

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

OhioHealth

Investigators

  • Principal Investigator: Deborah Napier, BSN,RN,MA, OhioHealth

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2014

Primary Completion (Actual)

September 1, 2015

Study Completion (Actual)

October 1, 2015

Study Registration Dates

First Submitted

July 17, 2014

First Submitted That Met QC Criteria

July 18, 2014

First Posted (Estimate)

July 22, 2014

Study Record Updates

Last Update Posted (Estimate)

October 21, 2016

Last Update Submitted That Met QC Criteria

August 30, 2016

Last Verified

August 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • OH1-14-00529

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

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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