Comparing Subsartorial Saphenous Nerve Blocks With and Without Dexamethasone for Anterior Cruciate Ligament Reconstruction

NCT ID: NCT01586806

Last Updated: 2016-11-28

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

195 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-07-31

Study Completion Date

2014-12-31

Brief Summary

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For patients undergoing Anterior Cruciate Ligament reconstruction surgery, the postoperative period can be a painful experience without adequate pain management. Hence the investigators propose a randomized controlled clinical study, investigating prolonged saphenous nerve blocks. Patients will be randomized to receive saphenous nerve blocks with or without dexamethasone, a corticosteroid used to prolong analgesia.

Depending on the randomized treatment assignment, patients may receive one of the following:

1. 13 ml of 0.5% bupivacaine, a local anesthetic (no dexamethasone);
2. 13 ml of 0.5% bupivacaine mixed with 1 mg of dexamethasone;
3. 13 ml of 0.5% bupivacaine mixed with 4 mg of dexamethasone.

Patients will be followed postoperatively. Following admission to the recovery room, data collectors will ask patients to rate their pain on a scale of 0-10 until discharge. Data collectors will also record patient satisfaction, pain medication use and any side effects experienced (i.e. nausea and vomiting). Patients will then be contacted on postoperative days 1, 2 and 14 and asked questions about their general well-being.

Detailed Description

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Conditions

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Anterior Cruciate Ligament Reconstruction Regional Anesthesia, Saphenous Nerve Block

Keywords

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Dexamethasone Glucocorticoids Physiological Effects of Drugs Therapeutic Uses Anterior Cruciate Ligament Reconstruction Regional Anesthesia, nerve block Ultrasonic Imaging Post-Operative Complications: muscle weakness, pain, nausea and vomiting Dexamethasone (as local anesthetic additive)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Control

Group Type PLACEBO_COMPARATOR

Bupivacaine Only

Intervention Type DRUG

This is the control treatment arm. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic).

Dexamethasone 1 mg

Group Type ACTIVE_COMPARATOR

Bupivacaine with 1 mg of Dexamethasone

Intervention Type DRUG

This is one of two treatment arms. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic), mixed with 1 mg of dexamethasone. Total injection volume will be 15 ml.

Dexamethasone 4 mg

Group Type ACTIVE_COMPARATOR

Bupivacaine with 4 mg of Dexamethasone

Intervention Type DRUG

This is one of two treatment arms. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic), mixed with 4 mg of dexamethasone. Total injection volume will be 15 ml.

Interventions

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Bupivacaine Only

This is the control treatment arm. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic).

Intervention Type DRUG

Bupivacaine with 1 mg of Dexamethasone

This is one of two treatment arms. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic), mixed with 1 mg of dexamethasone. Total injection volume will be 15 ml.

Intervention Type DRUG

Bupivacaine with 4 mg of Dexamethasone

This is one of two treatment arms. Patients will receive an ultrasound-guided saphenous nerve block, consisting of 13 ml of 0.5% bupivacaine (a local anesthetic), mixed with 4 mg of dexamethasone. Total injection volume will be 15 ml.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing ambulatory surgery for anterior cruciate ligament (ACL) reconstruction with a patella tendon autograft.
* ASA I-III \[American Society of Anesthesiologists (ASA) Physical Status classification system\]
* BMI \< 35
* Smokers included
* Ages 16-65

Exclusion Criteria

* Patients on steroids or requiring stress dose steroids
* BMI \> 35
* Patient refusal
* Allergy to study medications,
* NRS scores \> 3 with frequent opioid use (including tramadol) prior to surgery-daily for greater than 3 weeks
* Lower extremity neurological dysfunction
* Diabetic (NIDDM, insulin-dependent and/or oral hypoglycemic dependent)
* Not in included age range (under 16 or over 65 years of age)
* Contraindications to the use of dexamethasone
* Non-English speaking patients. We will be using the Short Form 8 Health Survey, as well as the OR-SDS questionnaire (these are in English; any translations would have to be separately validated).
Minimum Eligible Age

16 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital for Special Surgery, New York

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mary F. Chisholm, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital for Special Surgery, New York

Locations

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Hospital for Special Surgery

New York, New York, United States

Site Status

Countries

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United States

References

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Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 2010 Mar;27(3):285-8. doi: 10.1097/EJA.0b013e3283350c38.

Reference Type BACKGROUND
PMID: 20009936 (View on PubMed)

Cummings KC 3rd, Napierkowski DE, Parra-Sanchez I, Kurz A, Dalton JE, Brems JJ, Sessler DI. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011 Sep;107(3):446-53. doi: 10.1093/bja/aer159. Epub 2011 Jun 14.

Reference Type BACKGROUND
PMID: 21676892 (View on PubMed)

Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30A(9):1326-36. doi: 10.1016/0959-8049(94)90182-1.

Reference Type BACKGROUND
PMID: 7999421 (View on PubMed)

Apfelbaum JL, Gan TJ, Zhao S, Hanna DB, Chen C. Reliability and validity of the perioperative opioid-related symptom distress scale. Anesth Analg. 2004 Sep;99(3):699-709. doi: 10.1213/01.ANE.0000133143.60584.38.

Reference Type BACKGROUND
PMID: 15333398 (View on PubMed)

Lundblad M, Kapral S, Marhofer P, Lonnqvist PA. Ultrasound-guided infrapatellar nerve block in human volunteers: description of a novel technique. Br J Anaesth. 2006 Nov;97(5):710-4. doi: 10.1093/bja/ael241. Epub 2006 Sep 26.

Reference Type BACKGROUND
PMID: 17005509 (View on PubMed)

Akkaya T, Ersan O, Ozkan D, Sahiner Y, Akin M, Gumus H, Ates Y. Saphenous nerve block is an effective regional technique for post-menisectomy pain. Knee Surg Sports Traumatol Arthrosc. 2008 Sep;16(9):855-8. doi: 10.1007/s00167-008-0572-4. Epub 2008 Jun 24.

Reference Type BACKGROUND
PMID: 18574578 (View on PubMed)

Related Links

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http://www.hss.edu/

This is the link to Hospital for Special Surgery website.

Other Identifiers

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IRB #2012-002

Identifier Type: -

Identifier Source: org_study_id