Liposomal Bupivacaine Plus Bupivacaine Peripheral Nerve Blockade Versus Ropivacaine Plus Dexamethasone Peripheral Nerve Blockade for Arthroscopic Rotator Cuff Repair

NCT ID: NCT04737980

Last Updated: 2021-02-08

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

92 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-18

Study Completion Date

2020-03-18

Brief Summary

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This study is a comparison of analgesia effect from peripheral nerve blockade (PNB) with liposomal bupivacaine combined with bupivacaine compared to PNB with ropivacaine combined with dexamethasone for arthroscopic rotator cuff repair.

Detailed Description

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Arthroscopic rotator cuff repair(ARCR) addresses dysfunction and pain in individuals with rotator cuff tears who have failed conservative management. These procedures are typically performed in an outpatient setting. Single shot PNB with long acting local anesthetics have become the foundation of modern multimodal analgesia protocols. The reported analgesic benefits of PNB for shoulder surgery include reduced pain scores, opioid consumption, post-operative nausea and vomiting, improved postoperative recovery and improvement of patient satisfaction. However, standard PNB with bupivacaine or ropivacaine have been associated with rebound pain resulting in a sudden onset of pain that can be refractory to treatment and often necessitates the use of significant quantities of opioids.

Side effects of opioid consumption include nausea, vomiting, sedation, constipation, respiratory depression, hypotension, ileus, urinary retention, dehydration and addiction. It is therefore desirable to minimize the requirement for opioid consumption after ARCR.

Liposomal bupivacaine injectable suspension and its potential use for PNB has been a recent topic of interest in an effort to provide patients with longer acting pain control after shoulder surgery compared to the use of bupivacaine or ropivacaine. Liposomal bupivacaine has a delayed onset of action so its practical use for PNB for ARCR requires the additive of bupivacaine to reduce pain during and immediately after surgery as a bridge to the onset of liposomal bupivacaine.

The purpose of this study is to determine if PNB utilizing liposomal bupivacaine combined with bupivacaine performs favorably to standard PNB with ropivacaine combined with dexamethasone. Primary and secondary outcomes will be assessed including worst pain reported postoperatively on a numeric rating scale(NRS), postoperative opioid consumption reported as oral morphine equivalent dosage(OMED) and the overall benefit of anesthesia (OBAS) as reported by the OBAS score.

The hypothesis of this study is that PNB with liposomal bupivacaine combined with bupivacaine will translate to lower postoperative daily NRS pain scores, decreased daily and total OMED consumed and lower OBAS scores compared to PNB with ropivacaine combined with dexamethasone over the first 8 days following surgery.

Conditions

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Rotator Cuff Tears Shoulder Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study utilized two parallel arms for intervention. Participants were randomized to ultrasound guided PNB with liposomal bupivacaine combined with bupivacaine or PNB with ropivacaine combined with dexamethasone.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The participant was informed of which arm they were in after random draw as this information may have been important in the event they experienced side effects and needed to guide physician care at outside facilities. The anesthesiologist could not be masked regarding arm as the appearance of the medicine injected in both arms of the study was visibly different. The outcome assessor was masked by unique identifiers being applied to participants and outcome data kept separate from intervention arm until final analysis.

Study Groups

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Experimental Group: Interscalene block with liposomal bupivacaine combined with bupivacaine

Interscalene nerve block was performed utilizing ultrasound guidance with infiltration of 10 ml of liposomal bupivacaine 1.3% (133 mg) combined with 10 ml of 0.5% bupivacaine hydrochloride.

Group Type EXPERIMENTAL

Liposomal bupivacaine

Intervention Type DRUG

Injection of 10 ml of liposomal bupivacaine 1.3% (133 mg) for ultrasound guided interscalene block

Bupivacaine Hcl 0.5% Inj

Intervention Type DRUG

Injection of 10 ml of 0.5% bupivacaine hydrochloride as admixture for ultrasound guided interscalene block

Control Group: Interscalene block with ropivacaine combined with dexamethasone

Interscalene nerve block was performed utilizing ultrasound guidance with infiltration of 30ml of 0.5% ropivacaine combined with a 2 ml volume of 8mg of dexamethasone.

Group Type ACTIVE_COMPARATOR

Ropivacaine 0.5% Injectable Solution

Intervention Type DRUG

Injection of 30 ml of ropivacaine 0.5% injectable solution for ultrasound guided interscalene block

Dexamethasone

Intervention Type DRUG

Injection of 8mg (2ml) dexamethasone injectable as admixture

Interventions

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Liposomal bupivacaine

Injection of 10 ml of liposomal bupivacaine 1.3% (133 mg) for ultrasound guided interscalene block

Intervention Type DRUG

Bupivacaine Hcl 0.5% Inj

Injection of 10 ml of 0.5% bupivacaine hydrochloride as admixture for ultrasound guided interscalene block

Intervention Type DRUG

Ropivacaine 0.5% Injectable Solution

Injection of 30 ml of ropivacaine 0.5% injectable solution for ultrasound guided interscalene block

Intervention Type DRUG

Dexamethasone

Injection of 8mg (2ml) dexamethasone injectable as admixture

Intervention Type DRUG

Other Intervention Names

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Exparel

Eligibility Criteria

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Inclusion Criteria

* Full thickness tears of the Supraspinatus tendon
* Combined full thickness tears of the Supraspinatus and Infraspinatus tendon

Exclusion Criteria

* Age \< 18
* Revision surgery
* Chronic opioid use (\>3 months prior to surgery)
* Allergy to local anesthetics or opioids
* Workers compensation or medical legal claim
* Pulmonary disease
* NSAID intolerance
* Neurologic deficit of operative upper extremity
* Concomitant full thickness subscapularis tear

* 2 tendon rotator cuff tear
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Hospital for Special Surgery Florida

OTHER

Sponsor Role lead

Responsible Party

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ryan simovitch

Director-Shoulder Service

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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HSS Florida

West Palm Beach, Florida, United States

Site Status

Countries

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United States

References

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Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016 Jul;25(7):1204-13. doi: 10.1016/j.jse.2016.01.026. Epub 2016 Apr 11.

Reference Type RESULT
PMID: 27079219 (View on PubMed)

Hussain N, Brull R, Sheehy B, Essandoh MK, Stahl DL, Weaver TE, Abdallah FW. Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia. Anesthesiology. 2021 Feb 1;134(2):147-164. doi: 10.1097/ALN.0000000000003651.

Reference Type RESULT
PMID: 33372953 (View on PubMed)

Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis. Anesth Analg. 2015 May;120(5):1114-1129. doi: 10.1213/ANE.0000000000000688.

Reference Type RESULT
PMID: 25822923 (View on PubMed)

Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G. Interscalene Block with and without Intraoperative Local Infiltration with Liposomal Bupivacaine in Shoulder Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg Am. 2018 Aug 15;100(16):1373-1378. doi: 10.2106/JBJS.17.01416.

Reference Type RESULT
PMID: 30106818 (View on PubMed)

Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G. Randomized Controlled Trial of Interscalene Block Compared with Injectable Liposomal Bupivacaine in Shoulder Arthroplasty. J Bone Joint Surg Am. 2017 Apr 5;99(7):550-556. doi: 10.2106/JBJS.16.00296.

Reference Type RESULT
PMID: 28375887 (View on PubMed)

Kolade O, Patel K, Ihejirika R, Press D, Friedlander S, Roberts T, Rokito AS, Virk MS. Efficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2019 Sep;28(9):1824-1834. doi: 10.1016/j.jse.2019.04.054. Epub 2019 Jul 16.

Reference Type RESULT
PMID: 31324503 (View on PubMed)

Yan Z, Chen Z, Ma C. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis. Medicine (Baltimore). 2017 Jul;96(27):e7226. doi: 10.1097/MD.0000000000007226.

Reference Type RESULT
PMID: 28682872 (View on PubMed)

Patel MA, Gadsden JC, Nedeljkovic SS, Bao X, Zeballos JL, Yu V, Ayad SS, Bendtsen TF. Brachial Plexus Block with Liposomal Bupivacaine for Shoulder Surgery Improves Analgesia and Reduces Opioid Consumption: Results from a Multicenter, Randomized, Double-Blind, Controlled Trial. Pain Med. 2020 Feb 1;21(2):387-400. doi: 10.1093/pm/pnz103.

Reference Type RESULT
PMID: 31150095 (View on PubMed)

Wang K, Zhang HX. Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis. Int J Surg. 2017 Oct;46:61-70. doi: 10.1016/j.ijsu.2017.08.569. Epub 2017 Aug 24.

Reference Type RESULT
PMID: 28843463 (View on PubMed)

Other Identifiers

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JMC0023RSOP

Identifier Type: -

Identifier Source: org_study_id

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