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Postoperative Patient Controlled Epidural Analgesia After Total Knee Arthroplasty With 2ug/ml Fentanyl Combine With 0.2% Ropivacaine or 0.2% Levobupivcaine

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ClinicalTrials.gov Identifier: NCT01158586
Recruitment Status : Unknown
Verified February 2010 by United Christian Hospital.
Recruitment status was:  Recruiting
First Posted : July 8, 2010
Last Update Posted : July 8, 2010
Sponsor:
Information provided by:
United Christian Hospital

Brief Summary:

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)


Condition or disease Intervention/treatment Phase
Arthroplasty, Replacement, Knee Patient-controlled Analgesia Drug: Levobupivacaine Phase 4

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Study Start Date : April 2010
Estimated Primary Completion Date : September 2010
Estimated Study Completion Date : December 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Knee Replacement
Drug Information available for: Fentanyl
U.S. FDA Resources

Arm Intervention/treatment
Experimental: Levobupivacaine
patient control epidural analgeisa using 0.2% levobupivacaine with 2ug/ml fentanyl
Drug: Levobupivacaine
patient control epidural analgesia using 0.2% levobupivacaine with 2ug/ml fentanyl
Active Comparator: Ropivacaine
patient controlled epidural analgesia using 0.2% ropivacaine with 2ug/ml fentanyl
Drug: Levobupivacaine
patient control epidural analgesia using 0.2% levobupivacaine with 2ug/ml fentanyl



Primary Outcome Measures :
  1. Pain score [ Time Frame: 48hours after start epidural analgesia ]
    as well as complications from epidural analgesia are also going to record and monitored


Secondary Outcome Measures :
  1. cost/treatment [ Time Frame: 48hours ]


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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01158586


Contacts
Contact: Anthony Njo, MBBS; FHKCA; FANZCA 852-35136175 njokhnjo@yahoo.com.hk
Contact: Timothy Brake

Locations
Hong Kong
United Christian Hospital Recruiting
Hong Kong, Hong Kong
Sponsors and Collaborators
United Christian Hospital

Publications:
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.

Responsible Party: Dr. Anthony Kui Hung Njo, Hospital Authority
ClinicalTrials.gov Identifier: NCT01158586     History of Changes
Other Study ID Numbers: PCEA-LEVO-ROPI
First Posted: July 8, 2010    Key Record Dates
Last Update Posted: July 8, 2010
Last Verified: February 2010

Keywords provided by United Christian Hospital:
post total knee replacement
patient control
epidural analgesia

Additional relevant MeSH terms:
Fentanyl
Ropivacaine
Levobupivacaine
Bupivacaine
Analgesics, Opioid
Narcotics
Central Nervous System Depressants
Physiological Effects of Drugs
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Adjuvants, Anesthesia
Anesthetics, Intravenous
Anesthetics, General
Anesthetics
Anesthetics, Local