4-drug Nerve Block Versus Plain Local Anesthetic for Knee and Hip Arthroplasty Analgesia in Veterans
Summary
After total joint replacement, early hospital discharge to home (with patients capable of continuing a home-based rehabilitation program) is a cost- effective management strategy. This project will use improved local anesthetic nerve block techniques to enhance technical capability and clinical practice by (i) reducing pain and other morbidities during recovery, (ii) improving weight-bearing achievement during in-hospital physical therapy to allow for earlier return home, and (iii) continued rehabilitation as an outpatient at home when feasible (versus in an extended care facility).
Timeline
- Start
- 2016-10
- Primary completion
- 2021-07-12
- Completion
- 2021-08-20
Outcome
Met primary endpoint
paper the SF-MPQ-2 total score for the BPV-BCD group demonstrated greater pain reduction than that of the plain BPV group PMID 34730810 ↗
registry analysis (superiority test); Bupivacaine + BCD (Buprenorphine, Clonidine, Dexamethasone) vs Bupivacaine Only (Control Arm); p = 0.003; t-test, 2 sided NCT02891798 ↗
registry analysis (superiority test); Bupivacaine + BCD (Buprenorphine, Clonidine, Dexamethasone) vs Bupivacaine Only (Control Arm); p = 0.001; t-test, 2 sided NCT02891798 ↗
registry analysis (superiority test); Bupivacaine + BCD (Buprenorphine, Clonidine, Dexamethasone) vs Bupivacaine Only (Control Arm); p = 0.038; t-test, 2 sided NCT02891798 ↗
Publications
- Aloziem OU, Williams BA, Mikolic JM, Boudreaux-Kelly MY, Faruque S, Piva SR, Ibinson JW, Switzer GE. Assessing Common Content and Responsiveness of the QoR-15 and the SF-8 in the Context of Recovery from Regional Anesthesia for Joint Replacement. Mil Med. 2023 Nov 3;188(11-12):e3469-e3476. doi: 10.1093/milmed/usad191.
- Williams BA, Ibinson JW, Mikolic JM, Boudreaux-Kelly MY, Paiste HJ, Gilbert KL, Bonant SA, Ritter ME, Ezaru CS, Muluk VS, Piva SR. Day-One Pain Reductions After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine Nerve/Plexus Blocks: A Randomized Clinical Trial. Pain Med. 2022 Jan 3;23(1):57-66. doi: 10.1093/pm/pnab325.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Buprenorphine | Other / unclassified | — | Other |
| Subject | Clonidine | Other / unclassified | — | Other |
| Subject | Dexamethasone | Small molecule | — | Other |
| Background | Bupivacaine | Other / unclassified | — | Other |
Indications
No indication recorded.