- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02818894
Spinal Anesthesia in Total Hip Arthroplasty
Comparison of Lidocaine Versus Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty: A Randomized, Double-Blind, Prospective Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Most surgeons would agree total hip arthroplasty (THA) is one of the most successful surgical interventions. However, when it comes to the type of anesthesia to improve THA outcomes, surgeons do not agree. General anesthesia has been shown to be associated with increases in adverse events, increased operating room times and increased length of stay. Therefore, more surgeons are turning to spinal anesthesia for better pain control, decreased need for narcotics resulting in less nausea, sooner recovery of bowel function, and faster participation in physical therapy. All of these factors can lead to a sooner discharge from the hospital, which would lead to significant cost savings.
Transient neurological symptoms (TNS) are a concern of using spinal anesthesia and have been shown to occur up to 16-40% of the time with lidocaine. Symptoms of TNS have been described as pain, dysesthesia, or both that occur in the legs or buttocks and urinary retention after recovery from spinal anesthesia. Intensity of pain varies but can be quite severe. Symptoms can appear in a few hours, for up to 24 hours after surgery.
Lidocaine is the most widely used anesthetic due to its rapid onset, intense nerve blockade, and short duration of action. The risk of developing TNS after spinal anesthesia with lidocaine has been shown to be higher when compared to other anesthetics. However, it is unknown whether there are differences between patients who undergo spinal anesthesia with lidocaine versus bupivacaine in THA. This knowledge is important because it has been shown that bupivacaine spinal anesthesia is more effective than lidocaine with minimal adverse effects. A large randomized, prospective study is needed to prove the difference between the two types of anesthesia.
The primary objective of this study is to compare TNS among people who receive one of two spinal anesthesia treatments, lidocaine or bupivacaine. The study will be conducted on individuals who are indicated for THA and have agreed to have spinal anesthesia during their surgery. All patients will be randomized by a computer program and will receive either lidocaine or bupivacaine spinal anesthesia prior to their THA. In addition to TNS, other outcomes include urinary retention, hypotension, ambulation and length of hospital stay.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Georgia
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Atlanta, Georgia, United States, 30329
- Emory University Orthopaedic and Spine Hospital
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Atlanta, Georgia, United States, 30329
- The Emory Clinic
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Radiographic evidence of symptomatic osteoarthritis in one or bilateral hips. Osteoarthritis will be defined as pain with weight-bearing at the hip articulation together with radiographic findings
- Indicated for total hip arthroplasty
- Agreement to undergo spinal anesthesia for surgery
Exclusion Criteria:
- Patient refusal to undergo spinal anesthesia
- Patients with a known history of lumbar or sacral spinal fusion.
- Patients with a known history of prostate, urological, or kidney surgery.
- Patients who need monitoring of urine output during surgery (including patients with confirmed renal disease, renal failure, chronic renal insufficiency, or an indwelling catheter at the time of surgery).
- Current infection at site of injection
- Women of child-bearing potential who are on Medicare (child-bearing potential will be determined prior to surgery per Anesthesia standard of care)
- Hypovolemia
- Indeterminate neurologic disease
- Allergy or hypersensitivity to the study medications
- Currently taking any anti-coagulation medications or coagulopathic
- Increased intracranial pressure
- Subject is unable to make his/her own decision regarding the informed consent
- Subject is unable to read/understand English
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Lidocaine prior to THA
Participants scheduled for Total Hip Arthroplasty through anterior approach with Lidocaine spinal anesthesia and completing telephone questionnaires to see how they are feeling post-operation.
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Spinal anesthesia administered prior to participant's THA
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Active Comparator: Bupivacaine prior to THA
Participants scheduled for Total Hip Arthroplasty through anterior approach with Bupivacaine spinal anesthesia and completing telephone questionnaires to see how they are feeling post-operation.
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Spinal anesthesia administered prior to participant's THA
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Transient Neurological Symptoms (TNS) on Day 1 Post-Operation
Time Frame: Day 1 (day of surgery) Post-Operation
|
Following a prepared questionnaire, a study team member asked about TNS and pain that was not associated with the operation area.
The count of participants reporting any type of TNS is presented here.
|
Day 1 (day of surgery) Post-Operation
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Post-Operative Transient Neurological Symptoms Score on Day 1 Post-Operation
Time Frame: Day 1 (day of surgery) Post-Operation
|
Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area.
Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort.
|
Day 1 (day of surgery) Post-Operation
|
Number of Participants With Transient Neurological Symptoms on Post-Operative Day 7
Time Frame: Post-Operative Day 7
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Following a prepared questionnaire, a study team member asked about TNS and pain that was not associated with the operation area.
The count of participants reporting any type of TNS is presented here.
|
Post-Operative Day 7
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Transient Neurological Symptoms Score on Post-Operative Day 7
Time Frame: Post-Operative Day 7
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Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area.
Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort.
|
Post-Operative Day 7
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Number of Participants With Transient Neurological Symptoms on Post-Operative Day 14
Time Frame: Post-Operative Day 14
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Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain not associated with the operation area.
The count of participants reporting any type of TNS is presented here.
|
Post-Operative Day 14
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Transient Neurological Symptoms Score on Post-Operative Day 14
Time Frame: Post-Operative Day 14
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Following a prepared questionnaire, a study team member asked about symptoms of TNS and pain that was not associated with the operation area.
Participants were asked to grade the symptoms on a verbal analogue scale from 0 to 10, with zero as no discomfort and ten as unbearable discomfort.
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Post-Operative Day 14
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants Voiding Without Complications After Recovery From Spinal Anesthesia
Time Frame: Day 1 (day of surgery) Post-Operation
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Urine retention after recovery from spinal anesthesia was assessed as the count of participants voiding without complications.
Data were obtained through review of the inpatient records.
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Day 1 (day of surgery) Post-Operation
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Time to Ambulation After Recovery From Spinal Anesthesia
Time Frame: Day 1 (day of surgery) Post-Operation
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Time to ambulation after recovery from spinal anesthesia is assessed in minutes.
Information about time to full ambulation was obtained by asking participants or from inpatient medical charts.
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Day 1 (day of surgery) Post-Operation
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Count of Participants With Hypotension
Time Frame: Day 1 (day of surgery) Post-Operation
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The number of participants experiencing hypotension, defined as systolic blood pressure of <90 mmHg, is presented here.
Blood pressure information was obtained from reviewing the inpatient medical charts.
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Day 1 (day of surgery) Post-Operation
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Number of Participants Discharged 0, 1, or 2 Days Following Surgery
Time Frame: Up to Post-Operative Day 2
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Hospital length of stay was obtained from inpatient charts.
Length of stay was determined using the hospital admission dates and discharge dates, and was then categorized as being discharged the same day as the surgery, the day after surgery, or two days after surgery.
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Up to Post-Operative Day 2
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Thomas Bradbury, MD, Emory University
Study record dates
Study Major Dates
Study Start (Actual)
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
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Lidocaine
- Bupivacaine
Other Study ID Numbers
- IRB00083867
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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