Arthroplasty, Replacement, Knee Clinical Trial
Postoperative epidural analgesia (EA) is an effective and well-accepted modality of pain
relief technique after having total knee replacement operation(1,4). Patient controlled
epidural analgesia (PCEA) has been shown to be safe and effective in standard ward
setting(2) and results in reduced epidural analgesic requirements(3). Besides, it also bear
the advantage of avoidance of overdose, reduction of waiting times and involvement of
patients in their analgesic regimen(3). Both ropivacaine and levobupivacaine are the local
anaesthetic using in epidural analgesia which has been proven to be safe and effective(4).
0.2% Ropivacaine with 2ug/ml fentanyl has been used in our locality for more than 8 years.
Another local anaesthetics, levobupivacaine, a S-enantiomer of bupivacaine has come up in
Hong Kong, which has been proved to be safe, effective and may be better value for money.
These two drugs has been proven to have similar analgesic potency in using as EA for
postoperative pain relief for other operation(5,6,7) and for orthropaedics operation but in
different concentration(4). Concerns have been raised about the introduction of the
levobupivacaine in the departmental protocol. Objectives of this study are A)to determine
the equivalence of two local anaesthetics regimen ; 0.2% ropivacaine with 2ug/ml fentanyl
and 0.2% levobupivacaine with 2ug/ml fentanyl and B) to assess the cost-effectiveness of
using these two regimens.
The null hypothesis is that the difference of analgesic effect, presented with visual
analogue score, of two patient controlled epidural analgesia regimen, the 0.2% ropivacaine
with 2 ug/ml fentanyl and 0.2% levobupivacaine with 2ug/ml fentanyl is higher than the
threshold of 9 mm VAS. (8,9,10)
Status | Recruiting |
Enrollment | 60 |
Est. completion date | December 2010 |
Est. primary completion date | September 2010 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - > 18 years old, ASA I -III and - Undergoing total knee arthroplasty - Combine spinal-epidural anaesthesia Exclusion Criteria: - Known hypersensitivity to amide-type local anaesthetics - Known hypersensitivity to opioids - Known history of severe cardiovascular, renal, hepatic, neurological or psychiatric disease as judged by the investigator - Known history of peripheral neuropathies - Those receiving chronic analgesic therapy, or any contraindication for epidural analgesia (e.g. clotting disorders, or history of lumbar surgery) - Inability to perform a pain score, or pregnancy or lactation |
Allocation: Randomized, Endpoint Classification: Bio-equivalence Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Hong Kong | United Christian Hospital | Hong Kong |
Lead Sponsor | Collaborator |
---|---|
United Christian Hospital |
Hong Kong,
Reference 1. Block et al. Efficiancy of postoperative epidural analgesia: A meta-analysis. JAMA 290: 2455-63 2. Werawatganon T. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. The Cochrane Databas of systemic reviews. Issue 3 Art. No.: No.: CD 004044. DOI: 10.1002/14651858. CD004088.pub2. 3. Liu SS et al. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: propective experience with 1,030 surgical patients Anesthesiology 88: 388-95 4. Silvasti M et al. Patient-controlled analgesia versus continuous epidural analgesia after total knee arthroplasty Acta Anaesthesiol Scand 42: 576 - 80 5. Stand T et al. Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery. Can J Anaesth 50:258-64 6. Linda S. et al. Relative Analgesic Potencies of Levobupivacaine and Ropivacaine for Epidural Analgesia in Labor. Anesthesiology 2003; 99:1354-8 7. Marc Senard et al. Epidural Levobupivacaine 0.1% or Ropivacaine 0.1% Combined with Morphine Provides Comparable Analgesia After Abdominal Surgery Anesth Analg 2004;98:389-94 8. Kelly AM The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain.Emerg Med J 2001; 18:205-07 9. Mark MSM et al. The minimum clinically significant difference in visual analogue scale pain score in a local emergency setting. Hong Kong Journal of Emergency Medicine 2009; 16(4): 234-6 10. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998 Nov; 5(11): 1086-90.
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Pain score | as well as complications from epidural analgesia are also going to record and monitored | 48hours after start epidural analgesia | Yes |
Secondary | cost/treatment | 48hours | No |
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