CClinicalTrials.gg
CompletedNCT02713490Updated Dec 11, 2020Results posted

Local Infiltration Analgesia With and Without EXPAREL Following Total Knee Arthroplasty

A Phase 4 interventional study of EXPAREL and Bupivacaine in Pain, sponsored by Pacira Pharmaceuticals, Inc. Completed at 17 sites in United States. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-12-11.

Sponsored by Pacira Pharmaceuticals, Inc · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
140
Allocation
Randomized
Ages
18 Years and older
Sex
Male
01

Study summary

This is a Phase 4, multicenter, randomized, double-blind, controlled trial in approximately 140 adult subjects undergoing primary unilateral TKA under spinal anesthesia with bupivacaine HCl (10-15 mg).

Read the detailed description

On Day 0, eligible subjects will be randomized 1:1 to two treatment groups. Subjects in Group 1 will receive local infiltration analgesia (LIA) with EXPAREL 266 mg in 20 mL admixed with bupivacaine hydrochloride (HCl) 0.5% in 20 mL and expanded in volume with 80 mL normal saline (total volume of 120 mL). Subjects in Group 2 will receive LIA with bupivacaine HCl 0.5% in 20 mL expanded in volume with 100 mL normal saline (total volume of 120 mL). Investigators will use their usual surgical technique to perform the TKA.

Study drug will be administered using six 20 cc syringes with 22-gauge needles prior to wound closure. Each stick should deliver approximately 1-1.5 cc to the intended area. The tissue should visibly expand with minimal leakage. Study drug should be injected in the prescribed locations based on the areas of highest nerve density.

Infiltration Technique

Prior to cementation

Syringe #1: Posterior capsule (8-10 sticks medial and 8-10 sticks lateral).

Syringe #2: Femur medial and lateral periosteum, posterior periosteum, suprapatellar/quadriceps tendon (20 sticks).

Syringe #3: Tibia fat pad (5 sticks); pes anserinus, medial collateral ligament, and gutter (15 sticks).

Syringe #4: Circumferential periosteum (15-20 sticks).

After cementation

Syringe #5: Midline quadriceps tendon (10 sticks); retinaculum, medial gutter, femoral to tibia (10 sticks).

Syringe #6: Lateral gutter, femoral to tibial (10 sticks); subcutaneous/closure (10 sticks).

In addition to LIA, all study participants will receive a standardized approach for managing postsurgical pain that includes a scheduled multimodal pain regimen including adjunctive analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and rescue analgesics as needed.

Postsurgical clinical assessments will include pain intensity scores using a 10-cm visual analog scale (VAS); overall benefit of analgesia score (OBAS) questionnaire; total postsurgical opioid consumption; physical therapy assessment; nurse's satisfaction with overall analgesia; and discharge readiness. Adverse events (AEs) will be recorded from the time the informed consent form is signed through postsurgical Day 29.

Postsurgical health economic outcome assessments will include hospital length of stay (LOS), use of skilled nursing facility, outpatient physical therapy use, hospital readmissions, and use of other health services following discharge (phone calls related to postsurgical pain, unscheduled visits related to postsurgical pain, and visits to emergency department) through postsurgical Day 29.

A follow-up visit will be scheduled for all subjects on postsurgical Day 14. A follow-up phone call will be made on postsurgical Day 29 to all subjects who received study drug to assess for AEs.

02

Conditions studied

  • Pain
03

In context

Lead sponsor

Pacira Pharmaceuticals, Inc is the lead sponsor of 100 studies on the registry; 3 are open to participants now.

Of its 26 completed or terminated interventional studies of FDA-regulated products, 17 (65%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Male
Accepts healthy volunteers
No

Inclusion criteria

  1. Male or female, at least 18 years of age at screening.
  2. Scheduled to undergo primary, unilateral, tricompartmental TKA under spinal anesthesia.
  3. Primary indication for TKA is degenerative osteoarthritis of the knee.
  4. American Society of Anesthesiologists (ASA) physical status 1, 2, or 3.
  5. Female subjects must be surgically sterile; or at least 2 years postmenopausal; or have a monogamous partner who is surgically sterile; or practicing double-barrier contraception; or practicing abstinence (must agree to use double-barrier contraception in the event of sexual activity); or using an insertable, injectable, transdermal, or combination oral contraceptive approved by the FDA for greater than 2 months prior to screening and commit to the use of an acceptable form of birth control for the duration of the study and for 30 days after completion of the study.
  6. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments.

Exclusion criteria

Exclusion Criteria:

  1. Currently pregnant, nursing, or planning to become pregnant during the study or within 1 month after study drug administration.
  2. History of previous prior contralateral TKA or open knee surgery on the knee being considered for TKA. Prior arthroscopy is permitted.
  3. Planned concurrent surgical procedure (e.g., bilateral TKA).
  4. Undergoing unicompartmental TKA or revision TKA.
  5. Concurrent painful physical condition that may require analgesic treatment (such as an NSAID or opioid) in the postsurgical period for pain that is not strictly related to the knee surgery and which may confound the postsurgical assessments (e.g., significant pain from other joints including the non-index knee joint, chronic neuropathic pain, concurrent or prior contralateral TKA, concurrent foot surgery).
  6. Comorbidity impacting current physical function of Investigator opinion that it may impact postsurgical rehabilitation.
  7. Allergy, hypersensitivity, or contraindication to any of the study medications (i.e., bupivacaine, pregabalin, acetaminophen/paracetamol, celecoxib, oxycodone, morphine, hydromorphone, or tranexamic acid).
  8. Use of any of the following medications within the times specified before surgery: long-acting opioid medication or NSAIDs (except for low-dose aspirin used for cardioprotection) within 3 days, or any opioid medication within 24 hours.
  9. Initiation of treatment with any of the following medications within 1 month of study drug administration or if the medication(s) are being given to control pain: selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), gabapentin, pregabalin (Lyrica®), or duloxetine (Cymbalta®). If a subject is taking one of these medications for a reason other than pain control, he or she must be on a stable dose for at least 1 month prior to study drug administration.
  10. Current use of systemic glucocorticosteroids within 1 month of enrollment in this study.
  11. Use of dexmedetomidine HCl (Precedex®) within 3 days of study drug administration.
  12. History of coronary or vascular stent placed within the past 3 months (may be extended to 1 year if medically indicated per physician discretion).
  13. Have been treated for a deep vein thrombosis, pulmonary embolism, myocardial infarction, or ischemic stroke within the past 6 months (may be extended to 1 year if medically indicated per physician discretion).
  14. Rheumatoid or inflammatory arthritis or disease.
  15. Severely impaired renal or hepatic function (e.g., serum creatinine level >2 mg/dL [176.8 µmol/L], blood urea nitrogen level >50 mg/dL [17.9 mmol/L], serum aspartate aminotransferase [AST] level >3 times the upper limit of normal [ULN], or serum alanine aminotransferase [ALT] level >3 times the ULN.)
  16. Any neurologic or psychiatric disorder that might impact postsurgical pain or interfere with study assessments.
  17. Malignancy in the last 2 years, per physician discretion.
  18. History of misuse, abuse, or dependence on opioid analgesics, other prescription drugs, illicit drugs, or alcohol.
  19. Failure to pass the alcohol breath test or urine drug screen.
  20. Body weight \<50 kg (110 pounds) or a body mass index >40 kg/m2.
  21. Previous participation in an EXPAREL study.
  22. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug, whichever is longer, prior to study drug administration, or planned administration of another investigational product or procedure during the subject's participation in this study.
05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Investigator)
Enrollment
140 participants (actual)

Study arms

  • Active comparator
    EXPAREL

    Single dose of EXPAREL 266 mg in 20 mL admixed with bupivacaine HCl 0.5% in 20 mL and expanded in volume with 80 mL normal saline (total volume of 120 mL).

    Drug: EXPAREL

  • Active comparator
    Bupivacaine

    Bupivacaine HCl 0.5% in 20 mL expanded in volume with 100 mL normal saline (total volume of 120 mL).

    Drug: Bupivacaine

Interventions

  • DrugEXPAREL

    EXPAREL and bupivacaine HCl

    Also known as: bupivacaine liposome injectable suspension

  • DrugBupivacaine

    Single dose of bupivacaine HCl 0.5%

    Also known as: bupivacaine HCl

06

What researchers measure

Primary outcomes

  1. Area Under The Curve (AUC) of Visual Analog Scale (VAS) Pain Intensity Scores From 12 to 48 Hours

    AUC of VAS pain intensity scores from 12 to 48 hours, which represents total pain experienced from 12 to 48 hours. Visual Analog Scale (VAS) is a pain scale. The VAS was presented as a straight 10 cm line, where 0 cm is no pain and 10 cm is the worst pain possible. Patients were asked, "How much pain are you experiencing right now? Please place a vertical mark on the line below to indicate the level of pain you are experiencing right now."

    Time frame: From 12-48 hours

  2. Total Postsurgical Opioid Consumption Through 48 Hours

    Total postsurgical opioid consumption (converted to oral morphine equivalents) through 48 hours

    Time frame: 0-48 hours

Secondary outcomes

  1. Percentage of Opioid-free Subjects at 48 Hours

    Time frame: 48 hours

  2. Time to First Opioid Rescue in the First 48 Hours

    Time to first opioid rescue was estimated from Kaplan-Meier analysis and presented as quartiles (ie, time to rescue for the first 25% / 50% / 75% of subjects within each treatment group).

    Time frame: 48 hours

  3. Overall Benefit of Analgesia Score at 48 Hours

    The overall benefit of analgesic score (OBAS) comprises seven questions to assess pain intensity, adverse effects, and patients' satisfaction with analgesia (eg, "Please rate your current pain at rest on a scale between 0=minimal pain and 4=maximum imaginable pain"). Overall scores ranged between 0- 28. OBAS measures patients' benefit from postoperative pain therapy. A lower composite score indicates greater benefit from the therapy.

    Time frame: 48 hours

07

Results

Posted Dec 11, 2020

Participant flow

Participants were recruited between April 18, 2016 and February 8, 2017 at 16 sites in the United States

Participant flow — Overall Study
MilestoneEXPAREL 266 mg + Bupivacaine HClBupivacaine HCl
Started7169
Completed6867
Not completed32
Withdrew: Withdrawal by subject21
Withdrew: Did not receive study drug10
Withdrew: Met exclusion criteria01

Outcome measures

PrimaryArea Under The Curve (AUC) of Visual Analog Scale (VAS) Pain Intensity Scores From 12 to 48 Hours

AUC of VAS pain intensity scores from 12 to 48 hours, which represents total pain experienced from 12 to 48 hours. Visual Analog Scale (VAS) is a pain scale. The VAS was presented as a straight 10 cm line, where 0 cm is no pain and 10 cm is the worst pain possible. Patients were asked, "How much pain are you experiencing right now? Please place a vertical mark on the line below to indicate the level of pain you are experiencing right now."

Time frame:
From 12-48 hours
Reported as:
Least squares mean · cm*hr
Area Under The Curve (AUC) of Visual Analog Scale (VAS) Pain Intensity Scores From 12 to 48 Hours
cm*hrEXPARELBupivacaine
Area Under The Curve (AUC) of Visual Analog Scale (VAS) Pain Intensity Scores From 12 to 48 Hours181.523 ± 10.786208.407 ± 10.814
Statistical analysis
  • EXPAREL vs Bupivacaine · ANOVA · p = 0.0381 · Lsmd: -26.884 · 95% CI -56.608 to 2.841
PrimaryTotal Postsurgical Opioid Consumption Through 48 Hours

Total postsurgical opioid consumption (converted to oral morphine equivalents) through 48 hours

Time frame:
0-48 hours
Reported as:
Least squares mean · mg
Total Postsurgical Opioid Consumption Through 48 Hours
mgEXPARELBupivacaine
Total Postsurgical Opioid Consumption Through 48 Hours16.321 ± 6.68480.328 ± 33.249
Statistical analysis
  • EXPAREL vs Bupivacaine · ANOVA · p = 0.0029 · Lsm treatment ratio: 0.203 · 95% CI 0.065 to 0.631
SecondaryPercentage of Opioid-free Subjects at 48 Hours
Time frame:
48 hours
Reported as:
Count of participants · Participants
Percentage of Opioid-free Subjects at 48 Hours
ParticipantsEXPARELBupivacaine
Percentage of Opioid-free Subjects at 48 Hours70
Statistical analysis
  • EXPAREL vs Bupivacaine · Cochran-Mantel-Haenszel · p = 0.0088 · Treatment difference: 0.098 · 95% CI 0.0284 to 0.1685
SecondaryTime to First Opioid Rescue in the First 48 Hours

Time to first opioid rescue was estimated from Kaplan-Meier analysis and presented as quartiles (ie, time to rescue for the first 25% / 50% / 75% of subjects within each treatment group).

Time frame:
48 hours
Reported as:
Number · h
Time to First Opioid Rescue in the First 48 Hours
hEXPARELBupivacaine
First quartile2.617 (1.083 to 3.233)1.00 (0.600 to 1.967)
Median quartile4.125 (3.333 to 6.133)2.917 (2.083 to 3.883)
Third quartile9.667 (6.250 to 31.083)7.200 (4.00 to 12.600)
Statistical analysis
  • EXPAREL vs Bupivacaine · Log Rank · p = 0.0230
SecondaryOverall Benefit of Analgesia Score at 48 Hours

The overall benefit of analgesic score (OBAS) comprises seven questions to assess pain intensity, adverse effects, and patients' satisfaction with analgesia (eg, "Please rate your current pain at rest on a scale between 0=minimal pain and 4=maximum imaginable pain"). Overall scores ranged between 0- 28. OBAS measures patients' benefit from postoperative pain therapy. A lower composite score indicates greater benefit from the therapy.

Time frame:
48 hours
Reported as:
Mean · score on a scale
Overall Benefit of Analgesia Score at 48 Hours
score on a scaleEXPARELBupivacaine
Overall Benefit of Analgesia Score at 48 Hours4.1 ± 4.084.6 ± 4.33
Statistical analysis
  • EXPAREL vs Bupivacaine · Kruskal-Wallis · p = 0.4285

Adverse events

Collected over From screening to postsurgical day 29. Non-serious events are listed at a 2% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
EXPAREL0/70 (0%)1/70 (1.4%)45/70 (64.3%)
Bupivacaine0/69 (0%)1/69 (1.4%)39/69 (56.5%)
Most frequent serious events
Most frequent serious events
EventEXPARELBupivacaine
InfluenzaInfections and infestations0/701/69
Incision site cellulitisInfections and infestations1/700/69
Most frequent other events
Showing 10 of 19
Most frequent other events
EventEXPARELBupivacaine
NauseaGastrointestinal disorders21/7022/69
DizzinessNervous system disorders3/708/69
Muscle spasmsMusculoskeletal and connective tissue disorders6/700/69
VomitingGastrointestinal disorders5/705/69
HypokalemiaMetabolism and nutrition disorders4/701/69
AnemiaBlood and lymphatic system disorders1/703/69
ConstipationGastrointestinal disorders3/703/69
Peripheral swellingGeneral disorders1/703/69
ArthralgiaMusculoskeletal and connective tissue disorders3/703/69
HypotensionVascular disorders3/701/69

Baseline characteristics

Safety population included all participants who received study drug, with analysis by actual treatment received.

Age, Continuous
Age, Continuous(years)EXPARELBupivacaineTotal
Mean65.7 ± 8.6165.8 ± 7.2165.8 ± 7.92
Sex: Female, Male
Sex: Female, Male(Participants)EXPARELBupivacaineTotal
Female433982
Male273057
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)EXPARELBupivacaineTotal
Hispanic or Latino415
Not Hispanic or Latino6668134
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)EXPARELBupivacaineTotal
American Indian or Alaska Native101
Asian011
Native Hawaiian or Other Pacific Islander000
Black or African American7512
White6161122
More than one race123
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(participants)EXPARELBupivacaineTotal
United States7069139
Body mass index
Body mass index(kg/m^2)EXPARELBupivacaineTotal
Mean32.395 ± 5.80531.311 ± 5.18931.857 ± 5.515
VAS pain score
VAS pain score(cm)EXPARELBupivacaineTotal
Mean1.91 ± 2.1201.89 ± 2.2411.90 ± 2.174
American Association of Anesthesiologists classification
American Association of Anesthesiologists classification(Participants)EXPARELBupivacaineTotal
1325
2454085
3222749

1 further baseline measures are reported on the registry.

08

Study locations

17 sites
  • Institute for Joint Restoration
    Fremont, California 94538, United States
  • Loma Linda University
    Loma Linda, California 92354, United States
  • Holy Cross Hospital
    Fort Lauderdale, Florida 33334, United States
  • Cleveland Clinic Florida
    Weston, Florida 33331, United States
  • Pinnacle Orthopaedics & Sports
    Marietta, Georgia 30060, United States
  • Central DuPage Hospital, Northwestern Medicine
    Winfield, Illinois 60190, United States
  • Sinai Hospital of Baltimore
    Baltimore, Maryland 21215, United States
  • Orthopaedic Associates
    Towson, Maryland 21204, United States
  • NYU Hospital for Joint Disease
    New York, New York 10003, United States
  • Lenox Hill Hospital/Northwell Health Orthopaedic Institute
    New York, New York 10075, United States
  • UNC Orthopaedics Chapel Hill
    Chapel Hill, North Carolina 27599, United States
  • OrthoCarolina, PA
    Charlotte, North Carolina 28207, United States
  • Wellington Orthopaedics and Sports Medicine
    Cincinnati, Ohio 45209, United States
  • Cleveland Clinic
    Cleveland, Ohio 44195, United States
  • San Antonio Military Medical Center
    Fort Sam Houston, Texas 78234, United States
  • Baylor Medical Center, Plano Orthopedics Sports Medical & Spine Center
    Frisco, Texas 75034, United States
  • Utah University Orthopedic Center
    Salt Lake City, Utah 84108, United States
09

References and documents

Publications

  • Dysart SH, Barrington JW, Del Gaizo DJ, Sodhi N, Mont MA. Local Infiltration Analgesia With Liposomal Bupivacaine Improves Early Outcomes After Total Knee Arthroplasty: 24-Hour Data From the PILLAR Study. J Arthroplasty. 2019 May;34(5):882-886.e1. doi: 10.1016/j.arth.2018.12.026. Epub 2018 Dec 25. PubMed 30799269 ↗
  • Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local Infiltration Analgesia With Liposomal Bupivacaine Improves Pain Scores and Reduces Opioid Use After Total Knee Arthroplasty: Results of a Randomized Controlled Trial. J Arthroplasty. 2018 Jan;33(1):90-96. doi: 10.1016/j.arth.2017.07.024. Epub 2017 Jul 25. Erratum In: J Arthroplasty. 2019 Feb;34(2):399-400. doi: 10.1016/j.arth.2018.10.010. PubMed 28802777 ↗

Study documents

  • Study protocol · Jul 28, 2016
  • Statistical analysis plan · Feb 1, 2017

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Undecided

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Dec 11, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02713490
Lead sponsor
Pacira Pharmaceuticals, Inc
Responsible party
Sponsor
First posted
Mar 18, 2016
Start date
Apr 18, 2016
Primary completion
Feb 8, 2017
Completion
Feb 8, 2017
Results posted
Dec 11, 2020
Last update
Dec 11, 2020

Study contacts

James B Jones, MD, PharmD
study director · Pacira Pharmaceuticals, Inc

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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