The Efficiency of Periarticular Multimodal Drug Injection in Pain Management Following Primary Unilateral TKA

NCT ID: NCT06112548

Last Updated: 2024-05-02

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

RECRUITING

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-01

Study Completion Date

2025-11-30

Brief Summary

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This interventional study aims to compare the effectiveness of local multimodal drug periarticular injection in TKA patients with the standard pain control regime that includes opioids, NSAIDs, and other analgesics.

The main questions The investigators strive to answer are:

Is there a significant difference in the severity of pain and functional outcomes when applying periarticular injections? Are there any increased complications when applying the periarticular injections?

Detailed Description

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The best pain control regime following TKA is controversial. While opioids have an excellent analgesic effect, they also have many side effects. The investigators are conducting a randomized controlled trial to compare the severity of pain following primary unilateral TKA when multimodal drug periarticular injunction is used with the standard pain control regime. The investigators will enroll patients undergoing primary unilateral TKA and randomly allocate them into one treatment group. The first will undergo the procedure with periarticular injection before the closure is composed of a mixture of 20ml of low body weight bupivacaine 5mg/ml plus 1ml of ketorolac 30mg/ml plus 0.5ml adrenaline 1mg/ml injected in medial and lateral retinaculum, medial and lateral collateral ligaments, quadriceps and patellar tendon, joint capsule, subcutaneous fat, and the second will go standard TKA with pain control using opioids, NSAIDS, and paracetamol. The severity of postoperative pain is the primary outcome studied, as well as preoperative complications and any drug side effects, the data will be collected by a fellow researcher who is blinded to the interventions, and the patients will be blinded too. Randomization will be done by a research fellow who is not involved in patient treatment or care.

Conditions

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Arthritis Knee Pain Arthroplasty Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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TKA with pain management by multimodal periarticular injection.

Patients going TKA and getting an injection of a mixture of 20ml of low body weight bupivacaine 5mg/ml plus 1ml of ketorolac 30mg/ml plus 0.5ml adrenaline 1mg/ml injected in medial and lateral retinaculum, medial and lateral collateral ligaments, quadriceps and patellar tendon, joint capsule, subcutaneous fat before closure.

Group Type EXPERIMENTAL

primary unilateral TKA

Intervention Type PROCEDURE

Primary unilateral total knee arthroplasty with cruciate scarifying cemented DePuy Synthes PFC Sigma prosthesis.

Bupivacain

Intervention Type DRUG

low body weight (0.50%, 20cc) intraoperative periarticular injection

ketorolac

Intervention Type DRUG

1ml of 30mg/ml ketorolac intraoperative periarticular injection

epinephrine

Intervention Type DRUG

0.5ml Adrenaline 1mg/ml intraoperative periarticular injection

Tramadol

Intervention Type DRUG

IV Tramadol \[Ultram\] introduced when needed after surgery

TKA with pain management by IV/oral analgesics.

Patients going TKA and getting a standard pain control regime of IV opioids when needed, IV ketorolac, and IV/oral paracetamol.

Group Type EXPERIMENTAL

primary unilateral TKA

Intervention Type PROCEDURE

Primary unilateral total knee arthroplasty with cruciate scarifying cemented DePuy Synthes PFC Sigma prosthesis.

Paracetamol

Intervention Type DRUG

IV Paracetamol \[Ofirmev\] introduced every 6 hours after surgery

Ketorolac

Intervention Type DRUG

IV Ketorolac {Toradol} introduced every 12 hours after surgery.

Tramadol

Intervention Type DRUG

IV Tramadol \[Ultram\] introduced when needed after surgery

Interventions

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primary unilateral TKA

Primary unilateral total knee arthroplasty with cruciate scarifying cemented DePuy Synthes PFC Sigma prosthesis.

Intervention Type PROCEDURE

Bupivacain

low body weight (0.50%, 20cc) intraoperative periarticular injection

Intervention Type DRUG

ketorolac

1ml of 30mg/ml ketorolac intraoperative periarticular injection

Intervention Type DRUG

epinephrine

0.5ml Adrenaline 1mg/ml intraoperative periarticular injection

Intervention Type DRUG

Paracetamol

IV Paracetamol \[Ofirmev\] introduced every 6 hours after surgery

Intervention Type DRUG

Ketorolac

IV Ketorolac {Toradol} introduced every 12 hours after surgery.

Intervention Type DRUG

Tramadol

IV Tramadol \[Ultram\] introduced when needed after surgery

Intervention Type DRUG

Other Intervention Names

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Toradol Adrenaline

Eligibility Criteria

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Inclusion Criteria

* all patients with end-stage arthritis of the knee going primary unilateral total knee arthroplasty.

Exclusion Criteria

* inflammatory and secondary arthritis of the knee.
* Patients who are allergic to one or more of the drugs used in the injections.
* Patients who are already taking opioids for whatever reason or have a history of addiction.
* BMI less than 20 and more than 35.
* patients with intra-operative complications that would affect the outcomes measurement.
* Patients who are going through complex primary or revision TKA.
* Pregnancy, renal or liver failure.
* Patients who are classified as grade 3 or more according to ASA.
Minimum Eligible Age

50 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Damascus University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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jaber ibrahim, MD PHD

Role: STUDY_CHAIR

Damascus university - faculty of medicine - department of surgery

Locations

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Damascus university

Damascus, , Syria

Site Status RECRUITING

Countries

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Syria

Central Contacts

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jaber ibrahim, MD PHD

Role: CONTACT

944411241 ext. 963

Facility Contacts

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doried diri, MD

Role: primary

967388095 ext. 963

References

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Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97. doi: 10.2106/JBJS.D.02441.

Reference Type BACKGROUND
PMID: 15995115 (View on PubMed)

Hadley S, Day M, Schwarzkopf R, Smith A, Slover J, Zuckerman J. Is Simultaneous Bilateral Total Knee Arthroplasty (BTKA) as Safe as Staged BTKA? Am J Orthop (Belle Mead NJ). 2017 Jul/Aug;46(4):E224-E229.

Reference Type BACKGROUND
PMID: 28856350 (View on PubMed)

Lavernia CJ, Alcerro JC, Rossi MD. Fear in arthroplasty surgery: the role of race. Clin Orthop Relat Res. 2010 Feb;468(2):547-54. doi: 10.1007/s11999-009-1101-6. Epub 2009 Sep 18.

Reference Type BACKGROUND
PMID: 19763716 (View on PubMed)

Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002 Jun;3(3):159-80. doi: 10.1054/jpai.2002.123652. No abstract available.

Reference Type BACKGROUND
PMID: 14622770 (View on PubMed)

Shoji H, Solomonow M, Yoshino S, D'Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics. 1990 Jun;13(6):643-9. doi: 10.3928/0147-7447-19900601-08.

Reference Type BACKGROUND
PMID: 2367246 (View on PubMed)

Mahoney OM, Noble PC, Davidson J, Tullos HS. The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop Relat Res. 1990 Nov;(260):30-7.

Reference Type BACKGROUND
PMID: 1977542 (View on PubMed)

Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13.

Reference Type BACKGROUND
PMID: 19680735 (View on PubMed)

Sinatra R, Chung KS, Silverman DG, Brull SJ, Chung J, Harrison DM, Donielson D, Weinstock A. An evaluation of morphine and oxymorphone administered via patient-controlled analgesia (PCA) or PCA plus basal infusion in postcesarean-delivery patients. Anesthesiology. 1989 Oct;71(4):502-7. doi: 10.1097/00000542-198910000-00005.

Reference Type BACKGROUND
PMID: 2478049 (View on PubMed)

Allen GC, St Amand MA, Lui AC, Johnson DH, Lindsay MP. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial. Anesthesiology. 1993 Sep;79(3):475-80. doi: 10.1097/00000542-199309000-00010.

Reference Type BACKGROUND
PMID: 8363072 (View on PubMed)

Smith I, Van Hemelrijck J, White PF, Shively R. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg. 1991 Nov;73(5):536-9.

Reference Type BACKGROUND
PMID: 1952132 (View on PubMed)

Lonner J. Role of liposomal bupivacaine in pain management after total joint arthroplasty. J Surg Orthop Adv. 2014 Spring;23(1):37-41. doi: 10.3113/jsoa.2014.0037.

Reference Type BACKGROUND
PMID: 24641895 (View on PubMed)

Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. 2025 Feb 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK441940/

Reference Type BACKGROUND
PMID: 28722969 (View on PubMed)

Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006 Jan;15 Suppl 1(Suppl 1):S17-24. doi: 10.1007/s00586-005-1044-x. Epub 2005 Dec 1.

Reference Type BACKGROUND
PMID: 16320034 (View on PubMed)

Other Identifiers

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UDMS-Orthopedics-3-2023

Identifier Type: -

Identifier Source: org_study_id

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