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Efficacia dell'anestetico esteso somministrato dal chirurgo durante la chirurgia del ginocchio

24 settembre 2026 aggiornato da: The Cleveland Clinic

Uno studio pilota randomizzato, randomizzato, randomizzato per valutare l'efficacia clinica dell'esparel come un chirurgo posteromediale intra-articolare somministrato (IPSA) in soggetti sottoposti a artroplastica totale unilaterale del ginocchio unilaterale primario

Intra-articular Posteromedial Surgeon Administered (IPSA) Block in this study describes a new type of medical procedure where a surgeon provides anesthetic medication directly into a specific area inside a knee joint to numb the pain during knee surgery. Intra-articular refers to inside of knee joint, posteromedial refers to the back and inner side of a knee joint, and surgeon administered means a surgeon is performing the procedure.

Patients You will be randomly assigned to one of these three treatment groups:

Group 1:

Patients in this group will receive IPSA block and Local Infiltration Analgesia (LIA).

IPSA block is a pain numbing medication given by surgeon and injected inside the back and inner side of the knee joint. Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

Group 2 (Control):

Patients in this group will receive Adductor Canal Block (ACB) and Local Infiltration Analgesia (LIA). ACB is a pain numbing injection given by anesthesiologist near the adductor canal, a passage in the mid-thigh that contains nerves connecting the knee region. Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

Group 3:

Patients in this group will receive Local Infiltration Analgesia (LIA). Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

The study will evaluate;

  • How effective the pain relief is after surgery.
  • How much extra pain medication you need.
  • Your satisfaction with pain management and recovery
  • Any side effects.

Panoramica dello studio

Descrizione dettagliata

The study is a single-center, randomized, pilot study and will recruit up to 60 adult subjects undergoing unilateral total knee arthroplasty. Subjects will be randomized (1:1:1) to receive the treatments. The study participants will be followed for up to 90 days.

Information on analgesic use, pain, satisfaction with pain management will be obtained from patients. Participation begins when you sign the consent form. The treatment will begin on the day of the surgery. Follow up calls will be done 14 days and 90 days after surgery. Your involvement will last about 123 days.

Background and Rationale for the Study:

This study is being conducted to evaluate the clinical effectiveness of the Intra-articular Posteromedial Surgeon Administered (IPSA) block in subjects undergoing total knee arthroplasty (TKA). This study aims to demonstrate that a surgeon administered IPSA block can provide equivalent pain control to an anesthesiologist administered adductor canal block (ACB).

Method of Assigning Subjects to Treatment Randomization Scheme

Randomization Procedures Once a subject is identified as being qualified for the study in accordance with the eligibility criteria, the Investigator or designee will obtain a randomization assignment on the day of surgery. The subject will be considered randomized to the study once the study treatment is assigned.

Replacement of Subjects Subjects who withdraw from the study before the study treatment procedure may be replaced. Once a subject number is assigned, subject numbers will not be reused; subjects enrolled to replace those who withdraw will be assigned a unique subject number and randomized to treatment according to the procedures outlined above.

Subjects who are randomized but are withdrawn from the study before receiving the study drug may be replaced. Additionally, subjects may be replaced if insufficient and/or incomplete data are noted on safety or clinical outcomes.

Tipo di studio

Interventistico

Iscrizione (Stimato)

60

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

  • Nome: Sanalkumar Krishnan, PhD
  • Numero di telefono: 216-445-7194
  • Email: krishns11@ccf.org

Backup dei contatti dello studio

  • Nome: Jaime Shuster, PhD
  • Numero di telefono: 216- 906-0508
  • Email: shustej3@ccf.org

Luoghi di studio

    • Ohio
      • Cleveland, Ohio, Stati Uniti, 44113
        • Reclutamento
        • Cleveland Clinic Lutheran Hospital
        • Investigatore principale:
          • Matthew Deren, MD
        • Contatto:
          • Robert Molloy, MD
          • Numero di telefono: 216-445-5226
          • Email: molloyr@ccf.org

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Bambino
  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria: Inclusion Criteria:

Subjects must meet all of the following inclusion criteria to be eligible for participation:

1. Subjects ages 18 or older at screening 2. Indicated to undergo primary unilateral total knee arthroplasty under spinal anesthesia 3. Primary indication for TKA is degenerative osteoarthritis of the knee 4. American Society of Anesthesiologists (ASA) physical status 1, 2, or 3 (see Appendix 6) 5. Able to provide informed consent, adhere to the study schedule, and complete all study assessments 6. Body Mass Index (BMI) ≥18 and <40 kg/m2

-

Exclusion Criteria:

  • Subjects who meet any of the following exclusion criteria will not be eligible for participation in this study:

    1. Allergy, hypersensitivity, intolerance, or contraindication to any of the study medications for which an alternative is not named in the protocol (e.g., amide-type local anesthetics, opioids, bupivacaine HCl, NSAIDs)
    2. Planned concurrent surgical procedure (e.g., bilateral TKA)
    3. Undergoing unicompartmental TKA or revision TKA
    4. Concurrent painful physical condition (e.g. arthritis, fibromyalgia, cancer) that may require analgesic treatment with NSAIDs or opioids in the post dosing period for pain that is not strictly related to the knee surgery and which, in the Investigator's opinion, may confound the post dosing assessments
    5. Inadequate sensory function below the knee as assessed by the Investigator
    6. History of contralateral TKA within 1 year
    7. Previous open knee surgery on the knee being considered for TKA. Prior arthroscopy is permitted
    8. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years
    9. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug, whichever is longer, prior to study drug administration, or planned administration of another investigational product or procedure during the subject's participation in this study
    10. Previous participation in an EXPAREL study
    11. Uncontrolled anxiety, schizophrenia, or other psychiatric disorder that, in the opinion of the Investigator, could interfere with study assessments or compliance
    12. Currently pregnant, nursing, or planning to become pregnant during the study
    13. Clinically significant medical disease that, in the opinion of the Investigator, would make participation in a clinical study inappropriate. This includes diabetic neuropathy, coagulation or bleeding disorders, severe peripheral vascular disease, renal insufficiency, hepatic dysfunction or other conditions that would constitute a contraindication to participation in the study.
    14. Any use of marijuana [including Tetrahydrocannabinol (THC) and Cannabidiol (CBD)] within 30 days prior to randomization, or planned use during the course of the study
    15. Chronic opioid use (average ≥30 oral morphine equivalents/day) within 30 days prior to surgery

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Group 1

Patients in this group will receive IPSA block and Local Infiltration Analgesia (LIA).

Patients in this group will receive IPSA block and Local Infiltration Analgesia (LIA).

IPSA block is a pain numbing medication given by surgeon and injected inside the back and inner side of the knee joint. Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

Comparatore attivo: Group 2-Control (Standard of Care)

Patients in this group will receive Adductor Canal Block (ACB) and Local Infiltration Analgesia (LIA).

ACB is a pain numbing injection given by anesthesiologist near the adductor canal, a passage in the mid-thigh that contains nerves connecting the knee region. Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

Sperimentale: Group 3

Patients in this group will receive Local Infiltration Analgesia (LIA).

Local Infiltration Analgesia is a pain numbing medication injection given by the surgeon around the surgical knee area. The medications used in the procedure will be EXPAREL, and Bupivacaine HCL.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Questionnaires to assess the Pain levels of subjects enrolled in the study
Lasso di tempo: 120 days

Patients answer survey questionnaires about knee pain and general health. Pain levels will be taken regularly at 8, 24, 48 and 72 hours after surgery at the healthcare facility. Follow up questionnaire on pain levels will be done at 14 days and 90 days post-surgery. Patients share how satisfied they are with pain management at 72 hours, 14 days and 90 days after surgery.

Subject's Reported Pain (Numeric Rating Scale) Pain intensity scores Subject will evaluate their pain in the operative knee using an 11-point Numeric Rating Scale (NRS), where 0=no pain and 10=worst possible pain.

120 days
Evaluate safety and any side effects
Lasso di tempo: 120 days

Record any (i.e., adverse events [AEs]) related to the EXPAREL IPSA block for the enrolled subjects.

120 days
Medication usage
Lasso di tempo: 120 days

Information about concomitant medication usage including opioids and analgesics

120 days
Subject Satisfaction Assessments
Lasso di tempo: 120 days

Subject Satisfaction Assessments (Likert Scale) Subject Satisfaction with Pain Management

Overall satisfaction with your pain management. (Select one number only)

  1. Extremely dissatisfied
  2. Dissatisfied
  3. Neither satisfied nor dissatisfied
  4. Satisfied
  5. Extremely satisfied
120 days
Knee and general health survey
Lasso di tempo: 120 days

Questionnaires on knee health and general health. KOOS JR : Knee function will be assessed by the KOOS-JR questionnaire Forgotten Joint Score - 12: Joint Awareness questionnaires The Veterans RAND 12 Item Health Survey (VR-12): Health related quality of life will be assessed by the VR-12

120 days
Body Mass Index
Lasso di tempo: 120 days

weight and height measurements will be taken and calculated to report BMI in kg/m^2).

120 days

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Investigatori

  • Investigatore principale: Matthew Deren, MD, Associate Staff Orthopaedic Surgery

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

18 agosto 2025

Completamento primario (Stimato)

30 marzo 2027

Completamento dello studio (Stimato)

30 marzo 2027

Date di iscrizione allo studio

Primo inviato

16 aprile 2025

Primo inviato che soddisfa i criteri di controllo qualità

23 aprile 2025

Primo Inserito (Effettivo)

27 aprile 2025

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

25 settembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

24 settembre 2026

Ultimo verificato

1 settembre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • 25-033

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

NO

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

prodotto fabbricato ed esportato dagli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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