Arthritis Clinical Trial
Official title:
Evaluation of the Efficacy of Exparel Delivered Into the Posterior Capsule During Knee Replacement
Pain control after knee replacement requires analgesia to both the top (anterior) and bottom
(posterior) portion of the the knee. Presently we use a nerve block for the anterior
portion. The investigators want to to examine if giving Exparel into the posterior portion
will give better pain relief.
Hypothesis: There is no difference in, the use of analgesics or the length and quality of
analgesia and no decrease in the time to be able to accomplish simple to complex knee
movements using Exparel infiltration when compared to controls.
Objectives:
1. Is to assess the efficacy of pain control of Exparel vs. controls when injected into
the posterior capsular space after total knee arthroplasty
2. Asses the opioid use after Exparel vs. controls
3. Asses the time to simple and complex knee movement and ambulation.
4. The safety of Exparel will be assessed by the occurrence of all postsurgical adverse
events and serious adverse events through Day 30.
Methods:
After institutional review board (IRB) approval, 20 subjects will be consented to
participate in the study. The study includes subjects undergoing total knee arthroplasty
either under general or spinal anesthesia. This study will include men and women (18 - 75
years) who have American Society of Anesthesiologist physical classification status 1 - 3
and underwent total knee arthroplasty.
Subjects will be divided into two groups, Group A (control) to receive 20ml of saline while
Group B (study) to receive 20ml of liposomal bupivacaine into the posterior capsular space
during total knee arthroplasty. Patients from both groups will receive a femoral nerve block
with catheter placement for continuous infusion of local anesthetic. All subjects will have
access to rescue analgesics after surgery. Multimodal analgesia will supplement pain as per
standard care by the anesthesia team. Tylenol Orally 1g three times daily (not to exceed 4g
in 24hrs), oxycontin 10mg orally, twice/day, Celebrex 200 mg orally once a day and Percocet
5/325 prn will serve as this multimodal approach. The time, day and number of requests for
break through (additional) analgesia will be noted by both anesthesia team and primary care
team. Pain scores will be assessed using a 0 - 10 numeric scale. Pain will be assessed for
the following intervals: hospital arrival, PACU arrival, 2, 4, 8, 12, 24, 48, 72, hours
later and after hospital discharge 10 +/- 5 days after the block. Pain inquiries will assess
both posterior and anterior aspects of the knee. Pain at rest and for simple leg movements
(knee extension, straight leg raise) to fully ambulatory will be noted. These assessments
will be made in conjunction with rehabilitation and physical therapy specialists.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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