- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06291727
Mepivacaine vs Bupivacaine Spinal Anesthesia for TKA
Mepivacaine Versus Bupivacaine Spinal Anesthesia for Same Day Discharge Following Total Knee Arthroplasty
This study is a prospective, double-blind prospective randomized controlled trial comparing mepivacaine and bupivacaine spinal anesthesia for same-day discharge readiness following a unilateral primary elective TKA procedure.
Study data will be collected during the patient's hospital stay for their TKA procedure, and the primary outcome of same-day discharge readiness will be assessed the day of surgery. Patients will also be contacted at Day 3 post-op to assess for any complications, current level of pain, and pain medication utilization.
Study Overview
Status
Intervention / Treatment
Detailed Description
The purpose of this study is to evaluate the two different spinal anesthesia agents, mepivacaine and bupivacaine, and determine whether there are significant differences in their effects on readiness for same day discharge following a total knee arthroplasty.
This study is a prospective, double-blind prospective randomized controlled trial comparing mepivacaine and bupivacaine spinal anesthesia for same-day discharge readiness following a unilateral primary elective TKA procedure.
Study data will be collected during the patient's hospital stay for their TKA procedure, and the primary outcome of same-day discharge readiness will be assessed the day of surgery. Patients will also be contacted via telephone or RedCap at Day 3 post-op to assess for any complications, current level of pain, and pain medication utilization.
In this double-blind (patients and assessors) study, the patients will be randomly assigned 1:1 to receive one of the following: mepivacaine 1.5% (4.5ml, 67.5mg) or 2% (3.4ml, 67.5mg), (depending on availability from pharmacy) or hyperbaric bupivacaine 0.75% (1.4ml, 10.5mg) from the spinal kit. Randomization will be computer-generated in RedCap. These doses are the currently the standard doses used for our total knee arthroplasty patients. Patients with a height of 74 inches or greater or with body mass index of 35kg/m2 or greater will be given an extra 0.5ml of local anesthetic. The intraoperative anesthesia team will not be blinded to the group assignment, but patients, surgeons, and assessors are blinded. All patients will receive the standard preoperative multimodal analgesia, consisting of celecoxib 400mg po and acetaminophen 1gm po. Research staff will unblind the study investigators immediately if requested for any potential safety concerns.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Kyle J Adams, MS
- Phone Number: 864-455-3449
- Email: kyle.adams@prismahealth.org
Study Locations
-
-
South Carolina
-
Greenville, South Carolina, United States, 29615
- Recruiting
- Prisma Health Patewood Hospital
-
Contact:
- Kyle Adams
- Phone Number: 864-455-3449
- Email: Kyle.Adams@prismahealth.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient is at least 18 years of age who are scheduled for a primary elective TKA.
- Patient can ambulate at least 10 feet independently without human assistance.
- Patient must be a candidate for same day discharge as determined by American Society of Anesthesiologists (ASA) Physical Status Classification I and II
Exclusion Criteria:
- Patients scheduled for bilateral TKAs
- Contraindication to spinal anesthesia
- Revision TKAs
- Allergy or contraindication to NSAIDs (e.g. chronic anti-coagulant use)
- Workers' Compensation patient
- Type I Diabetes
- Type II Diabetes requiring insulin medication.
- Pre-operative narcotics use with the exception of tramadol.
- Renal insufficiency (GFR < 60) that may impact post-operative protocol
- Cognitive deficiencies that prevent the patient from providing their own informed consent
- Language barrier preventing completion of study forms in English
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: Mepivacaine
Standard dose of mepivacaine anesthesia (1.5% or 2%) for total knee arthroplasty procedure
|
Patients will be administered a standard dose of mepivacaine 1.5% (4.5ml, 67.5mg) for total knee arthroplasty prior to surgery
|
Active Comparator: Bupivacaine
Standard dose of hyperbaric bupivacaine anesthesia (0.75%) for total knee arthroplasty procedure
|
Patients will be administered a standard dose of 0.75% hyperbaric bupivacaine (1.4ml, 10.5mg) for total knee arthroplasty prior to surgery
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Same day discharge rate
Time Frame: 24 hours
|
Whether a patient is discharged the same day their surgery occurred, or if they were required to stay overnight following surgery.
|
24 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post-operative pain score as assessed by numeric rating scale (NRS)
Time Frame: 3 days
|
The NRS is a verbal pain scale that is evaluated on a scale of 0-10, with zero being no pain and 10 being 'the worst pain imaginable'.
NRS pain scores will be collected while in the post-anesthesia care unit (PACU), at each physical therapy visit until discharge, and at 3 days post-operatively.
|
3 days
|
Urinary retention as assessed by time at which patient can voluntarily void bladder post-operatively
Time Frame: 24 hours
|
Urinary retention will be evaluated based on whether patient is able to voluntarily void their bladder post-operatively.
Time at which patient is able to voluntarily void their bladder will be recorded.
|
24 hours
|
Return of sensory and motor function as assessed by ability of patient to plantar and dorsiflex lower extremity
Time Frame: 24 hours
|
Time until return to sensory and motor function will be evaluated based on whether patient is able to plantar or dorsiflex lower extremity after surgery.
Motor and sensory function will be considered 'intact' if patient is able perform these motions after surgery.
Motor function will be evaluated in the post-anesthesia care unit (PACU) and during hospital stay over the course of 24 hours post-operatively.
|
24 hours
|
Post-operative nausea and vomiting as assessed by clinical documentation of nausea and vomiting post-operatively
Time Frame: 24 hours
|
Nausea and vomiting will be evaluated based on the presence of clinical documentation of episodes of nausea and vomiting during hospital admission over the course of 24 hours.
|
24 hours
|
Pain Medications as evaluated by medical morphine equivalents
Time Frame: 24 hours
|
Post-operative medications will be documented by medical morphine equivalents of medications administered during hospital stay.
Total medical morphine equivalents over the course of 24 hours post-operatively will be used to capture pain medication usage during admission.
|
24 hours
|
Patient satisfaction levels as assessed by a 5-item Likert response scale
Time Frame: 3 days
|
Patient satisfaction levels will be captured using a 5-item Likert response scale with options of: 'very unsatisfied', 'unsatisfied', 'neutral', 'satisfied', and 'very satisfied' with respect to the type of anesthesia they received during their surgery.
Satisfaction will be evaluated at Day 3 post-operative follow-up call.
|
3 days
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Prisma Upstate
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Arthroplasty, Replacement, Knee
-
Fondazione Don Carlo Gnocchi OnlusCompletedArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipItaly
-
Bornholms RegionskommuneCompletedArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipDenmark
-
Central DuPage HospitalTerminatedTotal Knee Replacement | Replacement, Total Knee | Arthroplasty, Knee ReplacementUnited States
-
Campus Bio-Medico UniversityRecruitingArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipItaly
-
SCRI Development Innovations, LLCWithdrawnArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipUnited States
-
Sunnybrook Health Sciences CentreActive, not recruitingArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipCanada
-
University of British ColumbiaThe Arthritis Society, Canada; Centre for Aging SMART; Centre for Advancing Health...Not yet recruitingArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipCanada
-
University Hospital, Strasbourg, FranceRecruitingArthroplasty, Hip Replacement | Arthroplasty, Knee ReplacementFrance
-
Henry Ford Health SystemConsumer Sleep SolutionsNot yet recruitingArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipUnited States
-
Haute Ecole de Santé VaudCompletedArthroplasty, Replacement, Knee | Arthroplasty, Replacement, HipSwitzerland
Clinical Trials on Mepivacaine
-
Universitat Internacional de CatalunyaCompleted
-
Cairo UniversityNot yet recruitingSymptomatic Irreversible Pulpitis
-
Hospital for Special Surgery, New YorkCompletedArthroscopic Knee SurgeryUnited States
-
University Health Network, TorontoCompleted
-
Region SkaneNot yet recruitingCarpal Tunnel Syndrome
-
University Hospital, AntwerpCompletedSurgery | Anesthesia | Brachial Plexus Block | Nerve BlockBelgium
-
University of Campinas, BrazilFundação de Amparo à Pesquisa do Estado de São PauloCompletedLocal Anesthetic EffectivenessBrazil
-
Brigham and Women's HospitalMassachusetts Institute of TechnologyCompletedHealthy | Compartment Syndrome of LegUnited States
-
Centre Hospitalier Universitaire, AmiensCompleted
-
Medical University of South CarolinaRecruiting