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Phase 3 Adductor Canal Block With EXPAREL in Subjects Undergoing Primary Unilateral Total Knee Arthroplasty

Primary Purpose

Knee Osteoarthritis, Pain Management

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
bupivacaine liposome injectable suspension
Bupivacaine Hydrochloride
Sponsored by
Pacira Pharmaceuticals, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis focused on measuring EXPAREL, bupivacaine, analgesic, Adductor Canal Block, TKA, knee arthroplasty

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female, 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.
  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.

Exclusion Criteria:

  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. Currently on a neuromodulating agent (e.g., gabapentin, pregabalin [Lyrica], duloxetine [Cymbalta], etc.)].
  15. Current use of systemic glucocorticoids within 30 days of randomization in this study.
  16. Use of dexmedetomidine HCl (Precedex®) or clonidine within 3 days of study drug administration.
  17. 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.
  18. Chronic opioid use (average ≥30 oral morphine equivalents/day) within 30 days prior to randomization.

Given the COVID-19 pandemic, if there is a concern about a subject's recent or potential exposure to COVID-19, or if the subject is not medically fit/cleared for surgery due to suspected COVID-19 illness/symptoms, the subject must be excluded per Exclusion criterion #13.

Sites / Locations

  • Woodland International Research Group
  • Lotus Clinical Research
  • Midwest Clinical Research Center, LLC
  • First Surgical Hospital
  • HD Research- Legent Orthopedic Hospital
  • Endeavor Clinical Trials

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Active Comparator

Experimental

Active Comparator

Arm Label

Cohort 1: EXPAREL admix arm

Cohort 1: Bupivacaine HCl arm

Cohort 2: EXPAREL admix arm

Cohort 2: Bupivacaine HCl arm

Arm Description

subjects randomized to this treatment arm will receive 10 mL (133 mg) EXPAREL admixed with 10 mL (50 mg) 0.5% bupivacaine HCl

subjects randomized to this treatment arm will receive 10 mL (50 mg) 0.5% bupivacaine HCl mixed with 10 mL normal saline

subjects randomized to this treatment arm will receive 10 mL (133 mg) EXPAREL admixed with 10 mL (50 mg) 0.5% bupivacaine HCl

subjects randomized to this treatment arm will receive 10 mL (50 mg) 0.5% bupivacaine HCl mixed with 10 mL normal saline

Outcomes

Primary Outcome Measures

NRS scores through 96 hours post-surgery
The area under the curve (AUC) of the NRS pain intensity scores from 0 to 96 hours post-surgery.

Secondary Outcome Measures

Postsurgical Opioid Consumption through 96 hours post-surgery
Total postsurgical opioid consumption in oral morphine equivalents (OMED) from 0 to 96 hours post-surgery.
Time to first opioid
Time to first opioid consumption post-surgery
NRS scores
Worst and average NRS pain intensity scores at 24h, 48h, 72h and 96h from the end of surgery

Full Information

First Posted
November 15, 2021
Last Updated
September 6, 2022
Sponsor
Pacira Pharmaceuticals, Inc
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1. Study Identification

Unique Protocol Identification Number
NCT05139030
Brief Title
Phase 3 Adductor Canal Block With EXPAREL in Subjects Undergoing Primary Unilateral Total Knee Arthroplasty
Official Title
A Phase 3, Randomized, Double-Blind, Multicenter, Active-Controlled Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of EXPAREL Admixed With Bupivacaine HCl vs. Bupivacaine HCl Administered Via Adductor Canal Block for Postsurgical Analgesia in Subjects Undergoing Primary Unilateral Total Knee Arthroplasty
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Completed
Study Start Date
January 18, 2022 (Actual)
Primary Completion Date
July 1, 2022 (Actual)
Study Completion Date
July 11, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pacira Pharmaceuticals, Inc

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to compare magnitude of postsurgical analgesic effect in different groups following a single dose of study drug when administered via adductor canal block in subjects undergoing primary unilateral total knee arthroplasty.
Detailed Description
This is a Phase 3, multicenter, randomized, double-blind, active-controlled study in approximately 160 subjects undergoing primary unilateral TKA under spinal anesthesia. The study will have 2 cohorts, enrolling in parallel. Cohort 1 -PK, PD, Efficacy, and Safety, Cohort 2 -Efficacy and Safety An adaptive study design will be used in this study. An interim analysis to evaluate the sample size assumptions and evaluate futility will occur when a total of approximately 80 subjects (40 subjects in each arm) combined from either Cohort 1 or Cohort 2 have enrolled and provided complete assessment data for the primary efficacy outcome. The time from study drug administration until the end of participation is POD 14 (±3 days). Therefore, subjects may participate in the study for up to 62 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Knee Osteoarthritis, Pain Management
Keywords
EXPAREL, bupivacaine, analgesic, Adductor Canal Block, TKA, knee arthroplasty

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
Only study drug administrators (anesthesiologists) will be unblinded to perform the block procedures
Allocation
Randomized
Enrollment
167 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1: EXPAREL admix arm
Arm Type
Experimental
Arm Description
subjects randomized to this treatment arm will receive 10 mL (133 mg) EXPAREL admixed with 10 mL (50 mg) 0.5% bupivacaine HCl
Arm Title
Cohort 1: Bupivacaine HCl arm
Arm Type
Active Comparator
Arm Description
subjects randomized to this treatment arm will receive 10 mL (50 mg) 0.5% bupivacaine HCl mixed with 10 mL normal saline
Arm Title
Cohort 2: EXPAREL admix arm
Arm Type
Experimental
Arm Description
subjects randomized to this treatment arm will receive 10 mL (133 mg) EXPAREL admixed with 10 mL (50 mg) 0.5% bupivacaine HCl
Arm Title
Cohort 2: Bupivacaine HCl arm
Arm Type
Active Comparator
Arm Description
subjects randomized to this treatment arm will receive 10 mL (50 mg) 0.5% bupivacaine HCl mixed with 10 mL normal saline
Intervention Type
Drug
Intervention Name(s)
bupivacaine liposome injectable suspension
Other Intervention Name(s)
EXPAREL
Intervention Description
Adductor canal block with EXPAREL
Intervention Type
Drug
Intervention Name(s)
Bupivacaine Hydrochloride
Intervention Description
Adductor Canal Block with bupivacaine HCl
Primary Outcome Measure Information:
Title
NRS scores through 96 hours post-surgery
Description
The area under the curve (AUC) of the NRS pain intensity scores from 0 to 96 hours post-surgery.
Time Frame
0 to 96 hours post-surgery
Secondary Outcome Measure Information:
Title
Postsurgical Opioid Consumption through 96 hours post-surgery
Description
Total postsurgical opioid consumption in oral morphine equivalents (OMED) from 0 to 96 hours post-surgery.
Time Frame
0 to 96 hours post-surgery
Title
Time to first opioid
Description
Time to first opioid consumption post-surgery
Time Frame
0 to 96 hours post-surgery
Title
NRS scores
Description
Worst and average NRS pain intensity scores at 24h, 48h, 72h and 96h from the end of surgery
Time Frame
0-24hours, 0-48hours, 0-72hours, 0-96hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, ages 18 or older at screening. Indicated to undergo primary unilateral total knee arthroplasty under spinal anesthesia. Primary indication for TKA is degenerative osteoarthritis of the knee. American Society of Anesthesiologists (ASA) physical status 1, 2, or 3. Able to provide informed consent, adhere to the study schedule, and complete all study assessments. Body Mass Index (BMI) ≥18 and <40 kg/m2. Exclusion Criteria: 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). Planned concurrent surgical procedure (e.g., bilateral TKA). Undergoing unicompartmental TKA or revision TKA. 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. Inadequate sensory function below the knee as assessed by the Investigator. History of contralateral TKA within 1 year. Previous open knee surgery on the knee being considered for TKA. Prior arthroscopy is permitted. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years. 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. Previous participation in an EXPAREL study. Uncontrolled anxiety, schizophrenia, or other psychiatric disorder that, in the opinion of the Investigator, could interfere with study assessments or compliance. Currently pregnant, nursing, or planning to become pregnant during the study. 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. Currently on a neuromodulating agent (e.g., gabapentin, pregabalin [Lyrica], duloxetine [Cymbalta], etc.)]. Current use of systemic glucocorticoids within 30 days of randomization in this study. Use of dexmedetomidine HCl (Precedex®) or clonidine within 3 days of study drug administration. 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. Chronic opioid use (average ≥30 oral morphine equivalents/day) within 30 days prior to randomization. Given the COVID-19 pandemic, if there is a concern about a subject's recent or potential exposure to COVID-19, or if the subject is not medically fit/cleared for surgery due to suspected COVID-19 illness/symptoms, the subject must be excluded per Exclusion criterion #13.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gary Nevins
Organizational Affiliation
Pacira Pharmaceuticals, Inc
Official's Role
Study Director
Facility Information:
Facility Name
Woodland International Research Group
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
Lotus Clinical Research
City
Pasadena
State/Province
California
ZIP/Postal Code
91105
Country
United States
Facility Name
Midwest Clinical Research Center, LLC
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45417
Country
United States
Facility Name
First Surgical Hospital
City
Bellaire
State/Province
Texas
ZIP/Postal Code
77401
Country
United States
Facility Name
HD Research- Legent Orthopedic Hospital
City
Carrollton
State/Province
Texas
ZIP/Postal Code
75006
Country
United States
Facility Name
Endeavor Clinical Trials
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Phase 3 Adductor Canal Block With EXPAREL in Subjects Undergoing Primary Unilateral Total Knee Arthroplasty

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