Implementation of a Pain Management Protocol for Total Knee Arthroplasty

NCT ID: NCT02474654

Last Updated: 2019-01-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-07-31

Study Completion Date

2019-01-14

Brief Summary

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Study question: Is there an ideal combination of intraoperative long acting analgesics (periarticular infiltration (PI), femoral nerve block (FB) and intrathecal opioids (IO)) to optimize post-operative functional recovery, decrease overall narcotic consumption and enable faster 'readiness to discharge' for patients undergoing primary total knee replacement (TKR)?

Detailed Description

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Our study design is a five-arm double blinded randomized control trial. In order to create a blinded study, each participant will have all three interventions (Femoral Nerve Block (FB), Periarticular Injection (PI) and Intrathecal Opioid (IO)) performed during their visit. Normal saline (NS) will be substituted for opioid or local anesthetic in cases where a control is required.

Specific 5 arms include:

* Using all three anesthetics:

o PI + FB + IO (arm 1)
* Using a combination of two anesthetics + normal saline substitute for control:

* NS + FB + IO (arm 2)
* PI + NS + IO (arm 3)
* PI + FB + NS (arm 4)
* Control:

* NS + NS + IO (arm 5)

The control arm would include IO as the sole intervention as this is simply added to the spinal anesthetic used for the surgery itself. It is felt that having a study arm without any long-acting analgesic medication (opioid or local anesthetic) as the "control" arm following a spinal anesthetic would not meet current standard of care and cause harm to the participant

The investigators hypothesize that the combination of three forms of long acting analgesia (PI, FB, IO) will result in the greatest outcomes compared to a combination of any two or control. Our aim is to demonstrate that this optimal analgesic combination will have an additive pain control effect and will minimize side effects thus translating to less acute pain, improve patient mobility, and attaining "readiness to discharge" quicker.

Conditions

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Knee Replacement, Total

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Arm 1: PI+FNB+IO

Bupivicaine 15mg, Fentanyl 15mcg, Epimorphine 150mcg, 0.5% Ropivicaine with 1:400,000 Epinephrine 30ml, Ropivicaine 100ml, Epinephrine 600mcg, Ketorolac 30mg

Group Type EXPERIMENTAL

Bupivicaine

Intervention Type DRUG

15mg

Fentanyl

Intervention Type DRUG

15mcg

Epimorphine

Intervention Type DRUG

150mcg

Ropivicaine

Intervention Type DRUG

100 ml

Epinephrine

Intervention Type DRUG

600 mcg

Ketorolac

Intervention Type DRUG

30 mg

Ropivicaine with Epinephrine

Intervention Type DRUG

0.5% 1:400,000 30ml

Arm 2:NS+FNB+IO

Bupivicaine 15mg, Fentanyl 15mcg, Epimorphine 150mcg, 0.5% Ropivicaine with1:400,000 Epinephrine 30ml, Normal Saline 100ml

Group Type EXPERIMENTAL

Bupivicaine

Intervention Type DRUG

15mg

Fentanyl

Intervention Type DRUG

15mcg

Epimorphine

Intervention Type DRUG

150mcg

Normal Saline

Intervention Type DRUG

100 ml

Ropivicaine with Epinephrine

Intervention Type DRUG

0.5% 1:400,000 30ml

Arm 3: PI+NS+IO

Bupivicaine 15mg, Fentanyl 15mcg, Epimorphine 150mcg, Normal Saline 30ml, Ropivicaine 100ml, Epinephrine 600mcg, Ketorolac 30mg

Group Type EXPERIMENTAL

Bupivicaine

Intervention Type DRUG

15mg

Fentanyl

Intervention Type DRUG

15mcg

Epimorphine

Intervention Type DRUG

150mcg

Normal Saline

Intervention Type DRUG

30ml

Ropivicaine

Intervention Type DRUG

100 ml

Epinephrine

Intervention Type DRUG

600 mcg

Ketorolac

Intervention Type DRUG

30 mg

Arm 4: PI+FNB+NS

Bupivicaine 15mg, Fentanyl 15mcg, Normal Saline 0.3ml, 0.5% Ropivicaine with 1:400,000 Epinephrine 30ml, Ropivicaine 100ml, Epinephrine 600mcg, Ketorolac 30mg

Group Type EXPERIMENTAL

Bupivicaine

Intervention Type DRUG

15mg

Fentanyl

Intervention Type DRUG

15mcg

Normal Saline

Intervention Type DRUG

0.3 ml

Ropivicaine

Intervention Type DRUG

100 ml

Epinephrine

Intervention Type DRUG

600 mcg

Ketorolac

Intervention Type DRUG

30 mg

Ropivicaine with Epinephrine

Intervention Type DRUG

0.5% 1:400,000 30ml

Arm 5:NS+NS+IO

Bupivicaine 15mg, Fentanyl 15mcg, Epimorphine 150mcg, Normal Saline 30ml, Normal Saline 100ml

Group Type ACTIVE_COMPARATOR

Bupivicaine

Intervention Type DRUG

15mg

Fentanyl

Intervention Type DRUG

15mcg

Epimorphine

Intervention Type DRUG

150mcg

Normal Saline

Intervention Type DRUG

30ml

Normal Saline

Intervention Type DRUG

100 ml

Interventions

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Bupivicaine

15mg

Intervention Type DRUG

Fentanyl

15mcg

Intervention Type DRUG

Epimorphine

150mcg

Intervention Type DRUG

Normal Saline

0.3 ml

Intervention Type DRUG

Normal Saline

30ml

Intervention Type DRUG

Normal Saline

100 ml

Intervention Type DRUG

Ropivicaine

100 ml

Intervention Type DRUG

Epinephrine

600 mcg

Intervention Type DRUG

Ketorolac

30 mg

Intervention Type DRUG

Ropivicaine with Epinephrine

0.5% 1:400,000 30ml

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age 18 years or older
* primary total knee replacement for osteoarthritis
* agrees to a spinal anesthetic for TKR

Exclusion Criteria

* History of chronic pain or opioid tolerance (individuals requiring equivalent of 1 mg or more intravenous or 3 mg or more oral morphine per hour for greater than 1 month)
* general anesthetic for TKR
* major neurological deficit
* allergy to local anesthetic
* allergy to morphine or hydromorphone, anti-inflammatory, acetaminophen
* renal insufficiency
* liver failure
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Health Sciences North Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kim Wong, MD, FRCPC, BSc, PT

Role: PRINCIPAL_INVESTIGATOR

Health Sciences North

Locations

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Health Sciences North Research Institute

Greater Sudbury, Ontario, Canada

Site Status

Countries

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Canada

Other Identifiers

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15-009

Identifier Type: -

Identifier Source: org_study_id

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