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
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).
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.
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.
Exclusion Criteria:
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
Bupivacaine HCl 0.5% in 20 mL expanded in volume with 100 mL normal saline (total volume of 120 mL).
Drug: Bupivacaine
EXPAREL and bupivacaine HCl
Also known as: bupivacaine liposome injectable suspension
Single dose of bupivacaine HCl 0.5%
Also known as: bupivacaine HCl
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
Total Postsurgical Opioid Consumption Through 48 Hours
Total postsurgical opioid consumption (converted to oral morphine equivalents) through 48 hours
Time frame: 0-48 hours
Percentage of Opioid-free Subjects at 48 Hours
Time frame: 48 hours
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
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
Participants were recruited between April 18, 2016 and February 8, 2017 at 16 sites in the United States
| Milestone | EXPAREL 266 mg + Bupivacaine HCl | Bupivacaine HCl |
|---|---|---|
| Started | 71 | 69 |
| Completed | 68 | 67 |
| Not completed | 3 | 2 |
| Withdrew: Withdrawal by subject | 2 | 1 |
| Withdrew: Did not receive study drug | 1 | 0 |
| Withdrew: Met exclusion criteria | 0 | 1 |
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."
| cm*hr | EXPAREL | Bupivacaine |
|---|---|---|
| Area Under The Curve (AUC) of Visual Analog Scale (VAS) Pain Intensity Scores From 12 to 48 Hours | 181.523 ± 10.786 | 208.407 ± 10.814 |
Total postsurgical opioid consumption (converted to oral morphine equivalents) through 48 hours
| mg | EXPAREL | Bupivacaine |
|---|---|---|
| Total Postsurgical Opioid Consumption Through 48 Hours | 16.321 ± 6.684 | 80.328 ± 33.249 |
| Participants | EXPAREL | Bupivacaine |
|---|---|---|
| Percentage of Opioid-free Subjects at 48 Hours | 7 | 0 |
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).
| h | EXPAREL | Bupivacaine |
|---|---|---|
| First quartile | 2.617 (1.083 to 3.233) | 1.00 (0.600 to 1.967) |
| Median quartile | 4.125 (3.333 to 6.133) | 2.917 (2.083 to 3.883) |
| Third quartile | 9.667 (6.250 to 31.083) | 7.200 (4.00 to 12.600) |
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.
| score on a scale | EXPAREL | Bupivacaine |
|---|---|---|
| Overall Benefit of Analgesia Score at 48 Hours | 4.1 ± 4.08 | 4.6 ± 4.33 |
Collected over From screening to postsurgical day 29. Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| EXPAREL | 0/70 (0%) | 1/70 (1.4%) | 45/70 (64.3%) |
| Bupivacaine | 0/69 (0%) | 1/69 (1.4%) | 39/69 (56.5%) |
| Event | EXPAREL | Bupivacaine |
|---|---|---|
| InfluenzaInfections and infestations | 0/70 | 1/69 |
| Incision site cellulitisInfections and infestations | 1/70 | 0/69 |
| Event | EXPAREL | Bupivacaine |
|---|---|---|
| NauseaGastrointestinal disorders | 21/70 | 22/69 |
| DizzinessNervous system disorders | 3/70 | 8/69 |
| Muscle spasmsMusculoskeletal and connective tissue disorders | 6/70 | 0/69 |
| VomitingGastrointestinal disorders | 5/70 | 5/69 |
| HypokalemiaMetabolism and nutrition disorders | 4/70 | 1/69 |
| AnemiaBlood and lymphatic system disorders | 1/70 | 3/69 |
| ConstipationGastrointestinal disorders | 3/70 | 3/69 |
| Peripheral swellingGeneral disorders | 1/70 | 3/69 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 3/70 | 3/69 |
| HypotensionVascular disorders | 3/70 | 1/69 |
Safety population included all participants who received study drug, with analysis by actual treatment received.
| Age, Continuous(years) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| Mean | 65.7 ± 8.61 | 65.8 ± 7.21 | 65.8 ± 7.92 |
| Sex: Female, Male(Participants) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| Female | 43 | 39 | 82 |
| Male | 27 | 30 | 57 |
| Ethnicity (NIH/OMB)(Participants) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| Hispanic or Latino | 4 | 1 | 5 |
| Not Hispanic or Latino | 66 | 68 | 134 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| American Indian or Alaska Native | 1 | 0 | 1 |
| Asian | 0 | 1 | 1 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 7 | 5 | 12 |
| White | 61 | 61 | 122 |
| More than one race | 1 | 2 | 3 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(participants) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| United States | 70 | 69 | 139 |
| Body mass index(kg/m^2) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| Mean | 32.395 ± 5.805 | 31.311 ± 5.189 | 31.857 ± 5.515 |
| VAS pain score(cm) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| Mean | 1.91 ± 2.120 | 1.89 ± 2.241 | 1.90 ± 2.174 |
| American Association of Anesthesiologists classification(Participants) | EXPAREL | Bupivacaine | Total |
|---|---|---|---|
| 1 | 3 | 2 | 5 |
| 2 | 45 | 40 | 85 |
| 3 | 22 | 27 | 49 |
1 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
Plan to share: Undecided
This study is completed, as verified in Dec 2020. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Pacira Pharmaceuticals, Inc