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The Analgesic Efficacy of Local Anaesthetic Wound Infiltration Versus Intrathecal Morphine for Total Knee Replacement

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ClinicalTrials.gov Identifier: NCT01312415
Recruitment Status : Unknown
Verified March 2011 by Cork University Hospital.
Recruitment status was:  Recruiting
First Posted : March 10, 2011
Last Update Posted : March 10, 2011
Sponsor:
Information provided by:
Cork University Hospital

Brief Summary:

Total knee replacement (TKR) is associated postoperatively with considerable pain and analgesic requirement. Total knee replacement is routinely performed under spinal anaesthesia with intrathecal bupivacaine plus preservative free morphine. We hypothesize that infiltration of the surgical site with peri- and intraarticular levobupivacaine local anaesthetic would be an efficacious pain management technique and would not be inferior to intrathecal morphine for postoperative pain management.

We further hypothesize that the use of this surgical site infiltration technique would decrease post-operative systemic opioid requirements as well as the side effects associated with intrathecal and systemic opioids.


Condition or disease Intervention/treatment Phase
Total Knee Replacement Drug: Levobupivacaine Drug: Intrathecal morphine Phase 4

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Comparison of the Analgesic Efficacy of Local Anaesthetic Wound Infiltration Versus Intrathecal Morphine for Total Knee Replacement
Study Start Date : August 2010
Estimated Primary Completion Date : June 2011
Estimated Study Completion Date : June 2011

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U.S. FDA Resources

Arm Intervention/treatment
Experimental: levobupivacaine infiltration
Patients will receive spinal anaesthesia with intrathecal bupivacaine (17.5 or 15 mg) without morphine, and will receive peri- and intraarticular surgical site infiltration before wound closure with a solution of levobupivacaine 0.5% 2mg/kg body weight (maximum 200mg levobupivacaine) plus 0.5mg epinephrine made up to 100ml with saline. An intra-articular catheter will be placed by the surgeon before closure under the sterile surgical conditions and this will be left in situ in the wound. The patient will receive one further injection of 15ml of levobupivacaine 0.5% at 8am the following morning.
Drug: Levobupivacaine
Patients will receive peri- and intraarticular surgical site infiltration to the knee during surgery and before wound closure with a solution of levobupivacaine 0.5% 2mg/kg body weight (maximum 200mg levobupivacaine will be used if the patient's weight exceeds 100kg) plus 0.5mg epinephrine made up to 100ml with saline. An intra-articular catheter will be placed by the surgeon before closure under the sterile surgical conditions and this will be left in situ in the wound. The patient will receive one further injection of 15ml of levobupivacaine 0.5% solution at 8am on the morning of the first postoperative day after which the catheter will be removed.
Control
Patients will receive spinal anaesthesia with intrathecal bupivacaine 0.5% (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.3 mg).
Drug: Intrathecal morphine
Patients will receive spinal anaesthesia with intrathecal bupivacaine 0.5% (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.3 mg).



Primary Outcome Measures :
  1. Quality of analgesia in the postoperative period as assessed by visual analogue score (VAS) for pain at rest and on movement [ Time Frame: 24 hours postoperatively ]

Secondary Outcome Measures :
  1. Opioid consumption in total in the first 48 hours postoperatively [ Time Frame: 48 hours postoperatively ]


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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:

  • Patients scheduled for unilateral total knee replacement
  • Consent to spinal anaesthesia
  • ASA Grade I to III

Exclusion Criteria:

  • Patient refusal
  • Mini-Mental Score < 25 (see appendix 3)
  • Allergy to bupivacaine, morphine, paracetamol, diclofenac
  • Skin lesions/infection at site of injection
  • Uncorrected renal dysfunction
  • Coagulation disorders
  • chronic pain condition other than knee pain

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): NCT01312415


Contacts
Contact: Denise M McCarthy, MB FCARCSI 353-87-2341254 dmc_btown@yahoo.co.uk
Contact: Gabriella Iohom, MB PhD 353-21-4922135 iohom@hotmail.com

Locations
Ireland
St Mary Orthopedic Hospital Recruiting
Cork, Ireland
Sponsors and Collaborators
Cork University Hospital
Investigators
Principal Investigator: Denise M McCarthy, MB FCARSCI Cork University Hospital

Responsible Party: Denise McCarthy, Anaesthesia Specialist Registrar, Cork University Hospital, Cork, Ireland
ClinicalTrials.gov Identifier: NCT01312415     History of Changes
Other Study ID Numbers: TKR-SMOH
First Posted: March 10, 2011    Key Record Dates
Last Update Posted: March 10, 2011
Last Verified: March 2011

Keywords provided by Cork University Hospital:
total knee arthroplasty
total knee replacement
local infiltration analgesia
intra-articular local anaesthesia
patients undergoing total knee arthroplasty (total knee replacement)

Additional relevant MeSH terms:
Anesthetics
Bupivacaine
Levobupivacaine
Anesthetics, Local
Morphine
Analgesics
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Analgesics, Opioid
Narcotics