Postoperative Pain Control in Total Shoulder Arthroplasty

Total Shoulder Arthroplasty Clinical Trial

Official title:

A Prospective Randomized Controlled Trial to Evaluate the Efficacy of an Interscalene Brachial Plexus Block and Multimodal Analgesia With and Without Liposomal Bupivacaine for Postoperative Pain Control in Total Shoulder Arthroplasty

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05068960
• Other study ID #: IRB-19-7479
• Status: Recruiting
• Phase: Phase 4
• Start date: March 1, 2021
• Est. completion date: July 1, 2025

Study information

• Verified date: December 2023
• Source: Scripps Clinic
• Contact: Heinz Hoenecke, MD
• Phone: 858.554.7993
• Email: hoenecke.heinz[@]scrippshealth.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A double blind, prospective, randomized trial to evaluate postoperative pain, narcotic use, patient satisfaction, and function among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine.

Description:

In order to reduce narcotic abuse potential, orthopaedic surgeons have explored multimodal pain regimens in addition to regional anesthesia to improve postoperative pain control. One commonly used intervention to reduce postoperative shoulder pain has been the interscalene brachial plexus block. This block provides significant pain relief for shoulder procedures, but has been limited to less than 24 hours even with long acting anesthetics. In the setting of shoulder arthroplasty, this short-term pain control often leads to the need for increased narcotic pain medication. Since shoulder arthroplasty has been steadily increasing in the United States with an annual growth rate of 10.6%, it is imperative to control patients' postoperative pain without increasing their risk for opiate abuse. A potential method for achieving this is by using liposomal bupivacaine in the interscalene blocks.

This study is a double blind, prospective, randomized trial to evaluate the postoperative pain profiles among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine. The purpose of this study is to determine if patients undergoing shoulder arthroplasty with an interscalene brachial plexus block with liposomal bupivacaine (study group) or without liposomal bupivacaine (control group) will have differences in postoperative opiate consumption, patient-reported pain, satisfaction with surgery, and shoulder function.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: July 1, 2025
• Est. primary completion date: March 1, 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 50 Years to 85 Years

Eligibility

Inclusion Criteria:

• Patients undergoing primary shoulder arthroplasty or reverse shoulder arthroplasty

Exclusion Criteria:

• Patients under the age of 50 years

• Patients over the age of 85

• Patients undergoing a revision shoulder procedure

• Documented drug or alcohol abuse

• Active narcotic use within 3 months prior to surgery

• Neurological deficit

• Allergy to amide anesthetics

• Oxycodone intolerance

• Unable to take Celebrex

• Enrollment in another clinical trial

• Comorbidity that is contraindicated with the administration of an interscalene block

• Cognitive or mental health status that interferes with study

Related Conditions & MeSH terms

• Pain, Postoperative
• Total Shoulder Arthroplasty

Intervention

Drug:
• Liposomal bupivacaine
Addition of liposomal bupivacaine to the interscalene block for extended pain control following total shoulder arthroplasty
• Bupivacaine
Interscalene block with bupivacaine for pain control following total shoulder arthroplasty

Locations

Country	Name	City	State
United States	Scripps Clinic	La Jolla	California

Sponsors (1)

Lead Sponsor	Collaborator
Scripps Clinic

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Narcotic usage	Number and type of narcotic pain pills consumed during the first postoperative week (also converted into morphine equivalents)	Postoperatively (up to 1 week)
Secondary	Severity of pain and its impact on functioning (Brief Pain Inventory - Short Form modified)	Patients' self-reported pain severity and impact on functioning as measured on the Brief Pain Inventory Short-Form modified survey	Postoperatively (at 1 week)
Secondary	Pain score (Numeric Rating Scale): Preoperatively, postoperatively, and change from preoperatively to postoperatively	Patients' self-reported pain as measured on the Numeric Rating Scale	Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively
Secondary	American Shoulder and Elbow Surgeons (ASES) score: preoperatively, postoperatively, and change from preoperatively to postoperatively	The ASES score is a 100-point scale that evaluates two dimensions of shoulder function: pain and performance in activities of daily living. Each of the two domains make up for 50 of the 100 points. A score of 0 indicates the worst shoulder condition and a score of 100 indicates the best shoulder condition.	Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively
Secondary	Satisfaction with the results of surgery (Self-Administered Patient Satisfaction Scale)	Patients' satisfaction with results of surgery as measured on the Self-Administered Patient Satisfaction Scale	Postoperatively (at 4 weeks)
Secondary	Non narcotic pain medication usage	Number and type of non-narcotic pain pills consumed during the first postoperative week	Postoperatively (up to 1 week)