Surgeon-administered Exparel for pain control during total knee replacement

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This single-center, randomized pilot study will enroll up to 60 adults undergoing primary unilateral total knee arthroplasty and randomize them 1:1:1 to receive surgeon‑administered IPSA block plus local infiltration analgesia (LIA), an anesthesiologist‑administered adductor canal block (ACB) with LIA, or LIA alone, using Exparel (liposomal bupivacaine) and bupivacaine HCl as appropriate. Treatments are given on the day of surgery under spinal anesthesia and participants are followed for pain, analgesic use, and satisfaction with pain management through 14‑ and 90‑day follow‑up calls, with overall involvement lasting about 123 days. The primary comparisons focus on postoperative pain control and opioid consumption, with safety and patient satisfaction also tracked. The protocol is conducted at Cleveland Clinic Lutheran Hospital and is sponsored by the Cleveland Clinic with Pacira Pharmaceuticals as a collaborator.

Why it matters

Who can join: the full rules

Inclusion Criteria: Inclusion Criteria:

Subjects must meet all of the following inclusion criteria to be eligible for participation:

1\. Subjects ages 18 or older at screening 2. Indicated to undergo primary unilateral total knee arthroplasty 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 (see Appendix 6) 5. Able to provide informed consent, adhere to the study schedule, and complete all study assessments 6. Body Mass Index (BMI) ≥18 and \<40 kg/m2

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Exclusion Criteria:

* Subjects who meet any of the following exclusion criteria will not be eligible for participation in this study:

  1. Allergy, hypersensitivity, intolerance, or contraindication to any of the study medications for which an alternative is not named in the protocol (e.g., amide-type local anesthetics, opioids, bupivacaine HCl, NSAIDs)
  2. Planned concurrent surgical procedure (e.g., bilateral TKA)
  3. Undergoing unicompartmental TKA or revision TKA
  4. Concurrent painful physical condition (e.g. arthritis, fibromyalgia, cancer) that may require analgesic treatment with NSAIDs or opioids in the post dosing period for pain that is not strictly related to the knee surgery and which, in the Investigator's opinion, may confound the post dosing assessments
  5. Inadequate sensory function below the knee as assessed by the Investigator
  6. History of contralateral TKA within 1 year
  7. Previous open knee surgery on the knee being considered for TKA. Prior arthroscopy is permitted
  8. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years
  9. 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
  10. Previous participation in an EXPAREL study
  11. Uncontrolled anxiety, schizophrenia, or other psychiatric disorder that, in the opinion of the Investigator, could interfere with study assessments or compliance
  12. Currently pregnant, nursing, or planning to become pregnant during the study
  13. Clinically significant medical disease that, in the opinion of the Investigator, would make participation in a clinical study inappropriate. This includes diabetic neuropathy, coagulation or bleeding disorders, severe peripheral vascular disease, renal insufficiency, hepatic dysfunction or other conditions that would constitute a contraindication to participation in the study.
  14. Any use of marijuana \[including Tetrahydrocannabinol (THC) and Cannabidiol (CBD)\] within 30 days prior to randomization, or planned use during the course of the study
  15. Chronic opioid use (average ≥30 oral morphine equivalents/day) within 30 days prior to surgery

Where it's running

• Cleveland Clinic Lutheran Hospital
  Cleveland, Ohio, United States Recruiting

Study contacts

• Principal investigator: Matthew Deren, MD — Associate Staff Orthopaedic Surgery
• Study coordinator: Sanalkumar Krishnan, PhD
• Email: krishns11@ccf.org
• Phone: 216-445-7194

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.