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CompletedNCT03258697Updated Jun 4, 2024

The Pharmacokinetics and Effectiveness of Local LevoBupivacaine Injection on Primary Total Joint Replacement Model.

An interventional study of Levobupivacaine Hydrochloride in Arthropathy, sponsored by Chang Gung Memorial Hospital. Completed at 1 site in Taiwan. Open to participants aged 50 Years to 80 Years. Per ClinicalTrials.gov, last updated 2024-06-04.

Sponsored by Chang Gung Memorial Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
90
Allocation
Randomized
Ages
50 Years to 80 Years
Sex
All
01

Study summary

Total joint replacement is an ideal procedure to treat end stage joint disease. Good post-op pain relief could accelerate patient recovery and rehabilitation, and decrease admission days and medical cost. Local injection of LevoBupivacaine is an effective method in post-operative pain control. The effectiveness of local analgesia was noticed clinically. However, thorough studies about the pharmacokinetics of LevoBupivacaine, maintenance of effect, influence of post-operative rehabilitation are not well studied in different way of injection. The purpose of this study is to evaluate and analyze the pharmacokinetics and effect of local Levobupivacaine injection in different ways, the amount of post-operative fentanyl requirement after local injection, time to first fentanyl request, pain score, immediate post-operative function, side effect of analgesic agents, and medical cost, and to improve the quality of total joint replacement post-operative care.

Read the detailed description

Single large dose of LevoBupivacaine had been proved good analgesic effect in total joint replacement surgery. However, the safety was not well studied. For better understanding the effect and safety of local analgesic agent, we choose LevoBupivacaine with different injection way to find out. We divide patient to three groups, for comparing the effectiveness of LevoBupivacaine, and safety of LevoBupivacaine by checking intra-blood concentration. The pre-emptive analgesics and post-operative analgesics were the same as routine protocol in other total joint replacement.

02

Conditions studied

  • Arthropathy

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Keywords

  • Local analgesia, Pharmacokinetics, Total joint replacement
03

Who can participate

Ages eligible
50 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Primary total joint replacement, no previous open surgery on the same joint
  2. Age 50\~80 y/o, Pre-operative diagnosis: degenerative osteoarthritis
  3. Pre-operative deformity: varus \<15°, valgus \<15°, flexion contracture \<15°.
  4. Patients with normal heart function
  5. Willing to receive post-operative questionnaire and outpatient clinic follow-up

Exclusion criteria

Exclusion Criteria:

  1. Allergy to Patient-Controlled Analgesia or LevoBupivacaine
  2. Mental or cognitive illness that couldn't well response to questionnaire
  3. American Society Anesthesiologist more than III degree
  4. Liver cirrhosis, chronic renal insufficiency, heart disease or arrhythmia, insulin-dependent diabetes mellitus, and previous narcotic abuse history.
  5. Not suitable for using patient-controlled analgesia pump by evaluation of anesthesiologist
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Outcomes assessor)
Enrollment
90 participants (actual)

Study arms

  • No intervention
    Patient-Controlled Analgesia

    Patient had no local analgesic agent during total joint replacement. Patient had baseline Patient-Controlled Analgesia pump.

  • Active comparator
    Peri-articular LevoBupivacaine

    Patient had periarticular local analgesic agent, LevoBupivacaine Hydrochloride, during total joint replacement. Patient had baseline Patient-Controlled Analgesia pump.

    Drug: Levobupivacaine Hydrochloride

  • Experimental
    Intra-articular LevoBupivacaine

    Patient had intra-articular local analgesic agent, LevoBupivacaine Hydrochloride, during total joint replacement. Patient had baseline Patient-Controlled Analgesia pump.

    Drug: Levobupivacaine Hydrochloride

Interventions

  • DrugLevobupivacaine Hydrochloride

    Different way of LevoBupivacaine injection

    Also known as: Chirocaine

05

What researchers measure

Primary outcomes

  1. Dosage of analgesic opioid agent

    The total dosage of opioid agent after local LevoBupivacaine injection

    Time frame: post-operative day2

Secondary outcomes

  1. Blood concentration of LevoBupivacaine

    Venous return of local LevoBupivacaine could cause the difference of blood concentration

    Time frame: 25min, 90min, and coming morning after LevoBupivacaine injection

Other outcomes

  1. Functional score

    The difference of functional score

    Time frame: Baseline, Post-operative day1, day2, week2, week6, week12, week24

06

Study locations

1 site
  • Chang Gung Memorial Hospital, Linkou
    Taoyuan City, 333, Taiwan
07

References and documents

Publications

  • Chen CC, Yang CC, Hu CC, Shih HN, Chang YH, Hsieh PH. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):31-6. doi: 10.1097/AAP.0000000000000138. PubMed 25158837 ↗
  • Chen DW, Hu CC, Chang YH, Lee MS, Chang CJ, Hsieh PH. Intra-articular bupivacaine reduces postoperative pain and meperidine use after total hip arthroplasty: a randomized, double-blind study. J Arthroplasty. 2014 Dec;29(12):2457-61. doi: 10.1016/j.arth.2013.12.021. Epub 2013 Dec 19. PubMed 24439998 ↗
  • Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007 Sep;22(6 Suppl 2):33-8. doi: 10.1016/j.arth.2007.03.034. Epub 2007 Jul 26. PubMed 17823012 ↗
  • Wasudev G, Smith BE, Limbird TJ. Blood levels of bupivacaine after arthroscopy of the knee joint. Arthroscopy. 1990;6(1):40-2. doi: 10.1016/0749-8063(90)90095-u. PubMed 2310449 ↗
  • Meinig RP, Holtgrewe JL, Wiedel JD, Christie DB, Kestin KJ. Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy. Am J Sports Med. 1988 May-Jun;16(3):295-300. doi: 10.1177/036354658801600317. PubMed 3381989 ↗
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Registry details

Key details

Study ID
NCT03258697
Lead sponsor
Chang Gung Memorial Hospital
Responsible party
Sponsor
First posted
Aug 23, 2017
Start date
Oct 17, 2017
Primary completion
Jan 31, 2019
Completion
May 31, 2019
Last update
Jun 4, 2024

Study contacts

Wei-Chen Lo, M.S.
principal investigator · Chang Gung Memorial Hospital, Linkou, Taiwan

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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