Liposomal Bupivacaine vs Continuous Nerve Catheters for Below the Knee Amputations

NCT ID: NCT05140499

Last Updated: 2026-01-27

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

11 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-08-15

Study Completion Date

2025-12-23

Brief Summary

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Through this pilot prospective trial, we aim to obtain preliminary data investigating the effectiveness of perineural catheters and liposomal bupivacaine, both currently accepted as standard care at Maine Medical Center, for the management of post-limb amputation pain. We will use the data that we collect to inform the design of a larger, appropriately powered study.

Detailed Description

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Lower extremity amputation is a common surgical procedure often due to limb ischemia or complications related to diabetes mellitus. Managing postoperative pain can be quite challenging in this patient population and persistent post-surgical pain is not uncommon. Peripheral nerve catheters (PNCs) that deliver a continuous infusion of local anesthetic have been shown to provide analgesic benefit dependent upon infusion duration and in the absence of catheter malfunction. Unfortunately, PNCs can be difficult to place and rates of dislodgement are estimated at 30%. Single shot regional nerve blocks using liposomal bupivacaine are much easier to perform than PNCs and can provide up to 72 hours of pain relief, eliminating the need for catheter placement. To date, no study has investigated the effects of liposomal bupivacaine compared to PNCs for post-surgical pain control. In this pilot study, we intend to compare pain scores, opioid consumption, and length of stay in patients randomized to both treatment strategies. We also intend to conduct an exploratory analysis investigating incidence of phantom limb pain one month following surgery. Our results will inform the design of a larger powered study to investigate treatment effects.

Conditions

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Pain, Postoperative Amputation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Single Shot Perineural Popliteal Nerve Block

Single shot perineural popliteal nerve block injection of 10cc 13.3% liposomal bupivacaine combined with 15cc 0.50% bupivacaine hydrochloride within one hour prior to surgery

Group Type ACTIVE_COMPARATOR

Liposomal bupivacaine

Intervention Type DRUG

Popliteal nerve block

Continuous perineural popliteal nerve block catheter

Placement of continuous perineural popliteal nerve block catheter with injection of 30cc 0.5% bupivacaine within one hour prior to surgery, followed by continuous infusion of 10cc 0.3% ropivacaine (current standard practice) for at least 72 hours following surgery. Saphenous single shot 20cc 0.2

Group Type ACTIVE_COMPARATOR

Bupivacaine Hydrochloride 0.5 % Injectable Solution

Intervention Type DRUG

Continuous nerve catheter

Interventions

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Liposomal bupivacaine

Popliteal nerve block

Intervention Type DRUG

Bupivacaine Hydrochloride 0.5 % Injectable Solution

Continuous nerve catheter

Intervention Type DRUG

Other Intervention Names

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Exparel conventional bupivacaine

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists Physical Status Classification I-IV
* Scheduled for primary amputation or stump revision
* English speaking

Exclusion Criteria

* Patients unable to cooperate or consent to the study
* Allergy to local anesthetics
* Existing infection at planned needle insertion site
* BMI \> 40kg/m2
* Patients with a history of coagulopathy
* Emergency amputations
* Contralateral amputations
* Patients with a substance use disorder diagnosis
* Patients on opioids \>90 morphine milligram equivalents (MME)/day
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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MaineHealth

OTHER

Sponsor Role collaborator

Aurora Quaye

OTHER

Sponsor Role lead

Responsible Party

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Aurora Quaye

Vice Chair of Research, Department of Anesthesiology and Perioperative Medicine, Maine Medical Center

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Aurora Quaye, MD

Role: PRINCIPAL_INVESTIGATOR

MaineHealth

Locations

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Maine Medical Center

Portland, Maine, United States

Site Status

Countries

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United States

References

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Neil MJE. Pain after amputation. BJA Education. 2016: 16(3):107-12.

Reference Type BACKGROUND

Borg L, Howard SK, Kim TE, Steffel L, Shum C, Mariano ER. A comparison of strength for two continuous peripheral nerve block catheter dressings. Korean J Anesthesiol. 2016 Oct;69(5):506-509. doi: 10.4097/kjae.2016.69.5.506. Epub 2016 Jul 25.

Reference Type BACKGROUND
PMID: 27703632 (View on PubMed)

Borghi B, D'Addabbo M, White PF, Gallerani P, Toccaceli L, Raffaeli W, Tognu A, Fabbri N, Mercuri M. The use of prolonged peripheral neural blockade after lower extremity amputation: the effect on symptoms associated with phantom limb syndrome. Anesth Analg. 2010 Nov;111(5):1308-15. doi: 10.1213/ANE.0b013e3181f4e848. Epub 2010 Sep 29.

Reference Type BACKGROUND
PMID: 20881281 (View on PubMed)

Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011 Oct;113(4):904-25. doi: 10.1213/ANE.0b013e3182285e01. Epub 2011 Aug 4.

Reference Type BACKGROUND
PMID: 21821511 (View on PubMed)

Ilfeld BM. Continuous peripheral nerve blocks in the hospital and at home. Anesthesiol Clin. 2011 Jun;29(2):193-211. doi: 10.1016/j.anclin.2011.04.003.

Reference Type BACKGROUND
PMID: 21620338 (View on PubMed)

Bergese SD, Ramamoorthy S, Patou G, Bramlett K, Gorfine SR, Candiotti KA. Efficacy profile of liposome bupivacaine, a novel formulation of bupivacaine for postsurgical analgesia. J Pain Res. 2012;5:107-16. doi: 10.2147/JPR.S30861. Epub 2012 May 1.

Reference Type BACKGROUND
PMID: 22570563 (View on PubMed)

Prabhakar A, Ward CT, Watson M, Sanford J, Fiza B, Moll V, Kaye RJ, Morgan Hall O, Cornett EM, Urman RD, Kaye AD. Liposomal bupivacaine and novel local anesthetic formulations. Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):425-432. doi: 10.1016/j.bpa.2019.07.012. Epub 2019 Jul 19.

Reference Type BACKGROUND
PMID: 31791561 (View on PubMed)

Davidovitch R, Goch A, Driesman A, Konda S, Pean C, Egol K. The Use of Liposomal Bupivacaine Administered With Standard Bupivacaine in Ankle Fractures Requiring Open Reduction Internal Fixation: A Single-Blinded Randomized Controlled Trial. J Orthop Trauma. 2017 Aug;31(8):434-439. doi: 10.1097/BOT.0000000000000862.

Reference Type BACKGROUND
PMID: 28430722 (View on PubMed)

Mazloomdoost D, Pauls RN, Hennen EN, Yeung JY, Smith BC, Kleeman SD, Crisp CC. Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial. Am J Obstet Gynecol. 2017 Nov;217(5):598.e1-598.e11. doi: 10.1016/j.ajog.2017.07.001. Epub 2017 Jul 8.

Reference Type BACKGROUND
PMID: 28694151 (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 BACKGROUND
PMID: 28682872 (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 BACKGROUND
PMID: 33372953 (View on PubMed)

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006 May 13;367(9522):1618-25. doi: 10.1016/S0140-6736(06)68700-X.

Reference Type BACKGROUND
PMID: 16698416 (View on PubMed)

Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain. 2006 May;22(4):353-8. doi: 10.1097/01.ajp.0000177793.01415.bd.

Reference Type BACKGROUND
PMID: 16691088 (View on PubMed)

Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain. 1985 Mar;21(3):267-278. doi: 10.1016/0304-3959(85)90090-9.

Reference Type BACKGROUND
PMID: 3991231 (View on PubMed)

Madabhushi L, Reuben SS, Steinberg RB, Adesioye J. The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain. J Clin Anesth. 2007 May;19(3):226-9. doi: 10.1016/j.jclinane.2006.07.008.

Reference Type BACKGROUND
PMID: 17531734 (View on PubMed)

Jahangiri M, Jayatunga AP, Bradley JW, Dark CH. Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine. Ann R Coll Surg Engl. 1994 Sep;76(5):324-6.

Reference Type BACKGROUND
PMID: 7979074 (View on PubMed)

Lambert Aw, Dashfield Ak, Cosgrove C, Wilkins Dc, Walker Aj, Ashley S. Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation. Reg Anesth Pain Med. 2001 Jul-Aug;26(4):316-21. doi: 10.1053/rapm.2001.23934.

Reference Type BACKGROUND
PMID: 11464349 (View on PubMed)

Nikolajsen L, Ilkjaer S, Christensen JH, Kroner K, Jensen TS. Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet. 1997 Nov 8;350(9088):1353-7. doi: 10.1016/S0140-6736(97)06315-0.

Reference Type BACKGROUND
PMID: 9365449 (View on PubMed)

Nikolajsen L, Ilkjaer S, Jensen TS. Effect of preoperative extradural bupivacaine and morphine on stump sensation in lower limb amputees. Br J Anaesth. 1998 Sep;81(3):348-54. doi: 10.1093/bja/81.3.348.

Reference Type BACKGROUND
PMID: 9861117 (View on PubMed)

Morey TE, Giannoni J, Duncan E, Scarborough MT, Enneking FK. Nerve sheath catheter analgesia after amputation. Clin Orthop Relat Res. 2002 Apr;(397):281-9. doi: 10.1097/00003086-200204000-00032.

Reference Type BACKGROUND
PMID: 11953619 (View on PubMed)

Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S, Bhagwat D, Everton D, Burke LB, Cowan P, Farrar JT, Hertz S, Max MB, Rappaport BA, Melzack R. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain. 2009 Jul;144(1-2):35-42. doi: 10.1016/j.pain.2009.02.007. Epub 2009 Apr 7.

Reference Type BACKGROUND
PMID: 19356853 (View on PubMed)

Gallagher P, MacLachlan M. Development and psychometric evaluation of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Rehabilitation Psychology. 2000: 45(2), 130-154.

Reference Type BACKGROUND

Jensen MP, Castarlenas E, Tome-Pires C, de la Vega R, Sanchez-Rodriguez E, Miro J. The Number of Ratings Needed for Valid Pain Assessment in Clinical Trials: Replication and Extension. Pain Med. 2015 Sep;16(9):1764-72. doi: 10.1111/pme.12823. Epub 2015 Jul 14.

Reference Type BACKGROUND
PMID: 26178637 (View on PubMed)

Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics. 2005;4(4):287-91.

Reference Type BACKGROUND

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1807862-1

Identifier Type: -

Identifier Source: org_study_id

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