- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04257682
Regional Anesthesia in Total Hip and Knee Arthroplasty
Comparing Efficacy and Safety of Three Regional Anesthesia Regimens in Total Hip and Knee Arthroplasty: A Double Blind Randomized Control Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Advances in pain management, regional anesthesia, and focused rehabilitation have increased the popularity of outpatient total hip and knee arthroplasty in a select group of eligible patients. However, one of the main impediments to same-day discharge is the prolonged motor block post-spinal anesthesia, as patients are routinely kept in the post-anesthesia care unit (PACU) until they demonstrate that the spinal anesthesia has worn off.
At The Ottawa Hospital, the standard treatment for people receiving anesthesia during a total arthroplasty is the use of the anaesthetic, Bupivacaine. Mepivacaine and Ropivacaine are alternative anaesthetics that are also in use at The Ottawa Hospital. They are growing in popularity as anaesthetics because they and allow quicker recovery time when compared to Bupivacaine. Bupivacaine results in a long-lasting sensory-motor block, meaning that in the area that the local anesthesia was used, there is no sensation and limited movement for long periods of time. During hip or knee replacement surgery, you may want to have no sensation and the inability to move your lower limbs. However, it is not ideal for after surgery where weakness in the legs puts a person at increased risk for falls. Therefore, hospitalization after surgery typically lasts for a longer duration. Mepivacaine and Ropivacaine have a shorter motor block duration, allowing for a potentially earlier hospital discharge.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Faraj Abdallah
- Phone Number: 71887 613-613-737-8899
- Email: fabdallah@toh.ca
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients undergoing total hip or knee replacement
Exclusion Criteria:
- Study refusal
- Inability to provide consent
- Contra-indications to spinal anesthesia (refusal, infection, anti-coagulation, bleeding diathesis)
- Bilateral surgery
- Revision surgery
- Pre-exiting chronic pain or opioid consumption ≥ 30mg oxycodone or equivalent
- Pregnancy
- Not receiving preoperative adductor canal block for any reason
- Contra-indication to multimodal analgesia (acetaminophen or NSAIDs)
- Obstructive sleep apnea requiring extended PACU stay
- History of severe postoperative nausea and vomiting
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Bupivacaine
The participant will receive Bupivacaine as anesthesia during his or her planned total hip or knee replacement surgery.
|
Bupivacaine is a long-lasting dense sensory-motor block that can last up to four hours.
It will be administered once, as part of the spinal anesthetic.
The dosage varies based on age and joint, from 6.75 mg to 8.25 mg for the knee, and 7.5 mg to 9 mg for the hip.
Other Names:
|
Active Comparator: Ropivacaine
The participant will receive Ropivacaine as anesthesia during his or her planned total hip or knee replacement surgery.
|
Ropivacaine is a long-acting local anesthetic that is known for its differential sensory-motor block.
It will be administered once, as part of the spinal anesthetic.
The dosage varies based on age and joint, from 9 mg to 11 mg for the knee, and 10 mg to 12 mg for the hip.
Other Names:
|
Active Comparator: Mepivacaine
The participant will receive Mepivacaine as anesthesia during his or her planned total hip or knee replacement surgery.
|
Mepivacaine is an intermediate-acting local anesthetic producing shorting and motor-sparing blocks.
It will be administered once, as part of the spinal anesthetic.
The dosage varies based on age and joint, from 40 mg to 50 mg for the knee, and 45 mg to 55 mg for the hip.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Compare the effectiveness of Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine: proportion of patients with a failed spinal anesthetic
Time Frame: Day of surgery
|
Effectiveness will be measured by looking at the proportion of patients with a failed spinal anesthetic.
|
Day of surgery
|
Compare the cost profile of Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine.
Time Frame: Hospital discharge, approximately 1 day
|
Total costs associated with the providers involved and the costs associated with the time spent in the hospital following surgery but before discharge will be combined to report the cost profile
|
Hospital discharge, approximately 1 day
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Compare changes in post-operative pain associated with Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine.
Time Frame: Immediately after completion of surgery, every hour during PACU stay - approximately 3 hours, every 6 hours during hospital stay - approximately 1 day, 24 hours after surgery, one week post-operatively
|
Post-operative pain will be measured using a combination of the Visual Analogue Scale Pain Scores (VAS), time to first analgesic request in PACU, and recording post-operative opioid use.
|
Immediately after completion of surgery, every hour during PACU stay - approximately 3 hours, every 6 hours during hospital stay - approximately 1 day, 24 hours after surgery, one week post-operatively
|
Compare the safety of Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine.
Time Frame: 24 hours after surgery, one week post-operatively
|
Safety parameters will be compared by recording Adverse Events (AE)
|
24 hours after surgery, one week post-operatively
|
Compare the quality of the block provided by Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine.
Time Frame: During surgery, PACU discharge - approximately 3 hours
|
Quality of the block will compared by combing the the duration of total sensory and motor blocks and the number of patients who do not achieve a block at time of incision.
|
During surgery, PACU discharge - approximately 3 hours
|
Compare the length of stay for patients who received Ropivacaine and Mepivacaine spinal anesthetics to the current standard of care using Bupivacaine.
Time Frame: Immediately after surgery, PACU discharge - approximately 3 hours, SDC discharge - approximately 1 day, hospital discharge - approximately 1 day
|
Length of stay will be compared by recording the time of PACU discharge, SDC discharge, and hospital discharge.
|
Immediately after surgery, PACU discharge - approximately 3 hours, SDC discharge - approximately 1 day, hospital discharge - approximately 1 day
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Arthritis
- Osteoarthritis
- Osteoarthritis, Knee
- Osteoarthritis, Hip
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Anesthetics, Local
- Bupivacaine
- Ropivacaine
- Mepivacaine
Other Study ID Numbers
- 20190297-01H
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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