Effects of Sustained-release Oral Sodium Nitrite on Postoperative Pain and Recovery Following Total Knee Arthroplasty

Pain Clinical Trial

Official title:

Effects of Sustained-release Oral Sodium Nitrite Supplementation on Pain-related Outcomes and Peri- and Postoperative Physiology in People Undergoing Unilateral All-component Revision Total Knee Arthroplasty

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05893160
• Other study ID #: IRB-300010657
• Status: Not yet recruiting
• Phase: Phase 1
• Start date: August 1, 2024
• Est. completion date: August 1, 2026

Study information

• Verified date: June 2024
• Source: University of Alabama at Birmingham
• Contact: Shanna H Graves
• Phone: 205-975-2845
• Email: shannagraves[@]uabmc.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will determine whether a drug called sodium nitrite helps improve pain and post-operative recovery associated with knee replacement surgery.

Description:

The goal of this study is to examine the potential for oral sodium nitrite supplementation to reduce postoperative pain and inflammation and improve functional recovery in individuals undergoing unilateral revision total knee replacement. A sustained release formulation of sodium nitrite (40 mg) administered twice daily will be compared with placebo for a 30-day treatment period. Primary objectives are to evaluate pain and markers of functional improvement.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 80
• Est. completion date: August 1, 2026
• Est. primary completion date: July 1, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Male and female individuals aged 18-70

• Ambulatory with knee pain for greater than 6 months prior to surgery, and willing and able to comply with all study requirements will be considered eligible.

Exclusion Criteria:

• Severe hypertension (systolic blood pressure greater than or equal to 200 mmHg or diastolic blood pressure greater than or equal to 120 mmHg);

• BMI greater than 45 kg/m2;

• Active smoker or stopped smoking within 6 months of enrollment;

• Active local or systemic malignancy, such as lung cancer or leukemia;

• Cardiovascular disease resulting in dyspnea at rest;

• Peripheral neurovascular disease;

• Anemia;

• Hematological disease (eg, coagulopathy, sickle cell disease/anemia);

• Hemoglobin variant;

• Glucose-6-phosphate dehydrogenase deficiency;

• Methemoglobin reductase deficiency;

• Known sensitivity to nitrites;

• Liver disease;

• Use of phosphodiesterase type 5 inhibitors;

• Use of sildenafil (Viagra);

• Systemic treatment with antibiotics, immunosuppressants including corticosteroids, medications for migraine, allopurinol, tricyclic antidepressants, antihistamines, and/or nitrates currently or in the last month;

• Use of nitrovasodilators (e.g. GTN) within the last month;

• Use of protein pump inhibitors within the last month;

• History of substance abuse;

• Recent surgery or hospitalization (within last 6 months);

• Inability to swallow a pill;

• Failure to provide full consent;

• Involvement with a worker's compensation, personal injury, or other legal matter related to participant health.

Related Conditions & MeSH terms

• Pain

Intervention

Drug:
• JAN101 SR
The dosage form of JAN101 to be used in clinical investigations is a sustained release (SR) tablet containing Sodium Nitrite drug substance.

Other:
• Placebo
Inert placebo formulation

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
University of Alabama at Birmingham

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Opioid Requirements	Patients	30 days
Primary	Short-form McGill Pain Questionnaire (SF-MPQ)	The SF-MPQ is a validated test for the measurement of pain. The measure is calculated by summing the point values for responses to 15 questions. Questions 1-11 deal with the sensory dimension of pain (i.e., the quality of the pain). Questions 12-15 deal with the affective dimension of pain (i.e., how the pain affects you). Subscores for the sensory and affective dimensions are calculated, in addition to a total McGill Pain Score. In addition, there is a visual analogue scale for pain and a final question about pain intensity. Higher scores generally correspond to a worse subjective experience of pain.	30 days
Primary	Brief Pain Inventory (BPI) short form	The BPI is a questionnaire used to assess the severity of pain (intensity) and its impact on functioning (interference). It uses a 0-10 numeric rating scale for item rating and has no scoring algorithm. Pain severity can be measured as the arithmetic mean of the four severity items, with a lower score indicating less pain. Pain interference can be measured from arithmetic mean of the seven interference items, with a lower score indicating less interference.	30 days
Primary	Pain ratings	Ratings of pain intensity (PI) and pain unpleasantness (PU) will be obtained. A description of the difference between PI (ie, "how strong the pain feels") and PU (ie, "how unpleasant or disturbing the pain is for you") will be read to all participants. Following this, PI and PU will be assessed by asking participants for verbal self-reports on a 0-100 scale, with 0 = "No pain" or "Not at all unpleasant" and 100 = "Pain as intense as I can imagine" or "Pain as unpleasant as I can imagine". Numeric rating scales of PI and PU have demonstrated validity through their ability to detect treatment effects, as well as their strong association with other measures of sensory and affective components of pain.	30 days
Primary	Quality of Recovery (QoR-15) questionnaire	The QoR-15 scale is a measurement of the quality of recovery from surgery and anesthesia measured in five domains: physical comfort, pain, physical independence, psychological support, and emotional state. The QoR-15 scale provides a score ranging from 0 to 150, with a high score indicating a good quality of recovery.	30 days
Primary	Physical function	Performance-based measure of physical function will be obtained using a goniometer to measure range of motion (ROM), in degrees from 0-180, at the knee joints. A lower numeric ROM indicates worse physical function.	30 days
Primary	Leg girth measurement	Girth measurements of both legs will be made while participants are in a reclined position. Knee joint circumference will be measured (in cm), and thigh circumference will be measured (in cm) at 5 cm and 10 cm above the kneecap while thigh muscles are contracted. Measurements will be used to calculate a Limb Symmetry Index ([circumference of injured leg / circumference of uninjured leg] * 100).	30 days
Primary	White blood cell count	Blood will be drawn for the measurement of white blood cell (WBC) count in # of WBCs per microliter.	30 days
Primary	Immune cell markers	CD11b/CD18 is a member of the leukocyte integrin family of heterodimeric adhesion molecules expressed on hematopoietic cells and are regarded as immune cell markers. Blood content of CD11b/CD18 expressing cells will be measured using flow cytometry with relative staining and optical density.	30 days
Primary	Blood markers v1	Soluble P-selectin, F2-isoprostanes, protein carbonyls, tumor necrosis factor (TNF) alpha, CC chemokine ligand 2 (CCL2), protaglandin E2 (PGE2), and pentraxin 3 (PTX3) will be measured in blood plasma as indices of infection, oxidative stress, and inflammation. They will be quantified in units of pg/ml, where lower levels indicate less infection, oxidative stress, and inflammation.	30 days
Primary	Blood markers v2	8-OH-deoxyguanine, nitrate, and nitrite will be measured in blood plasma as indices of oxidative damage and nitric oxide homoeostasis. They will be quantified in micromolar (uM) concentration, where lower levels indicate less oxidative damage.	30 days
Primary	Timed-Up-and-Go test	This is a test for measuring the functional mobility. Participants will be timed during rising from an armchair, walking 3 meters, turning around, walking back, and sitting down again. Participants will be allowed to use the armrests and will be wearing their shoes.	30 days