Serum Levels of Bupivacaine in Autotransfusion Drains Following Total Joint Arthroplasty

Completed

• Conditions: Knee Pain Arthritis
• Interventions: Drug: periarticular bupivicaine and liposomal bupivicaine

• Registration Number: NCT02276040
• Lead Sponsor: OrthoCarolina Research Institute, Inc.

Brief Summary

The purpose of this study is to quantify the total blood serum levels of bupivacaine in OrthoPAT® collected blood 2 hours and 5 hours postoperatively.

Hypothesis: Filtered blood from the OrthoPAT® autotransfusion system contains low or undetectable levels of bupivacaine hydrochloride (HCL). Reinfusion of collected blood from the OrthoPAT® device when used in conjunction with periarticular bupivicaine injections will not pose a bupivocaine toxicity risk to patients undergoing a total joint arthroplasty.

Detailed Description

Total joint arthroplasty (TJA) is a commonly performed surgical procedure that can result in considerable postoperative pain which can limit social and functional recovery and a return to quality of life. Traditionally, pain control following TJA has been conducted with parenteral and oral narcotics. Recently, a number of studies have demonstrated the efficacy of multimodal analgesia following a variety of surgical procedures.1-2 These multimodal regimens vary and consist of any number of medications including narcotics, non-steroidal anti-inflammatories, anti-epileptics, and peripheral nerve blocks among others. These multimodal regimens have been associated with a reduction in the use of opioid analgesics, leading to fewer opioid-associated adverse events.3-5 One of the newest modalities introduced on the market is liposomal bupivacaine, trade name Exparel. The advertised advantage of liposomal bupivacaine compared with bupivacaine HCL is a longer duration of analgesia owing to gradual release from the liposomes. Liposomal bupivacaine is employed in a periarticular injection at the conclusion of TJAs to aid in post-operative pain control.

Patients receive a periarticular injection of liposomal bupivacaine intra-operatively during TJA. At the conclusion of the procedure, a specialized intra-articular drain (OrthoPAT®) is placed. The OrthoPAT® perioperative autotransfusion system collects the patient's blood in the immediate postoperative period and then allows for it to be transfused to the patient while on the floor.

A potential risk, although low, is the concern for bupivicaine toxicity. Toxicity from bupivicaine is associated with central nervous system issues (seizures) and cardiac toxicity. Toxicity is dose dependent and recommended levels should not exceed 400mg/24 hr period. With autotransfusion, there is a theoretical concern that blood, potentially with increased levels of bupivicaine, could be reinfused into the vascular system and create toxicity.

Study Timeline

• Study Start: 2014-10
• Study First Submitted: 2014-10-21
• Study First Submitted QC: 2014-10-23
• Study First Posted: 2014-10-27
• Primary Completion: 2015-06
• Study Completion: 2017-06-30
• Status Verified: 2017-07
• Results First Submitted: 2017-07-07
• Results First Submitted QC: 2017-07-07
• Last Update Submitted: 2017-07-07
• Results First Posted: 2017-11-30
• Last Update Posted: 2017-11-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 26

Inclusion Criteria

• Patients undergoing primary total joint arthroplasty with use of periarticular bupivicaine and liposomal bupivicaine and OrthoPAT® auto reinfusion system.
• At least 18 years of age.

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Exclusion Criteria

• Allergy to bupivacaine.
• Allergy to epinephrine.
• Patients that are not presenting for a primary TJA
• Patients who are having a TJA without OrthoPAT® auto reinfusion system.
• Patients under age 18.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Exparel	periarticular bupivicaine and liposomal bupivicaine	Participants will receive Exparel (periarticular bupivicaine and liposomal bupivicaine).

Primary Outcome Measures

Name	Time	Method
Change in Blood Serum Levels of Bupivocaine From Baseline	Change from baseline at 2 and 5 hours post-dose	Bupivocaine levels measured in the blood that is collected in a surgical drain post surgery. Blood samples will be tested for change in serum bupivicaine levels from baseline.

Trial Locations

Locations (3)

OrthoCarolina, PA; 🇺🇸 Charlotte, North Carolina, United States

Novant Health Charlotte Orthopedic Hospital; 🇺🇸 Charlotte, North Carolina, United States

OrthoCarolina Research Institute, OrthoCarolina, P.A.; 🇺🇸 Charlotte, North Carolina, United States