EXPAREL Facia Iliaca Compartment Block for Intertrochanteric Hip Fracture

Study Overview
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Brief Summary
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This study evaluates the effect of EXPAREL on total opioid consumption through 72 hours following fascia iliaca compartment block (FICB) in subjects undergoing repair of intertrochanteric hip fracture.

Detailed Description
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The current standard of care treatment for pain relief in patients with intertrochanteric hip fracture is a FICB with continuous infusion of ropivacaine given via catheter. In this study, some people will receive a single injection FICB with EXPAREL + bupivacaine HCl. The groups will be evaluated to determine the amount of pain medication they took from the FICB to 72 hours after.

Official Title
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A Phase-4, Multicenter, Randomized, Active-Controlled Study to Evaluate the Efficacy and Safety of EXPAREL When Administered Via Fascia Iliaca Compartment Block Versus Fascia Iliaca Compartment Block With Continuous Infusion of Ropivacaine Per Standard of Care Through a Catheter in Intertrochanteric Hip Fracture Patients

Conditions
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Hip Fractures, Intertrochanteric Fractures

Intervention / Treatment
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* Drug: EXPAREL
* Drug: Ropivacaine
* Drug: Bupivacaine Hydrochloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals between 65 and 85 years of age (inclusive of) at screening. Intertrochanteric femoral fractures with American Society of Anesthesiology physical status 1, 2, or 3. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments. Exclusion Criteria: Hip fracture that requires total arthroplasty. Patients transferred from other hospitals. Patients that have other acute fractures. Pre-existing dementia (Mini-Mental State examination score <20) or delirium (Mini-Mental State examination score <24). 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, ropivacaine, acetaminophen, NSAIDs). Serious systemic comorbidities that cause a contraindication for EXPAREL/bupivacaine (severe hepatic or renal impairment) or ropivacaine. Use of anticoagulants (including aspirin, except low dose aspirin). Chronic opioid use of ≥ 20 morphine milligram equivalent (MME)/day for more than 7 days in the last 30 days. Body Mass Index (BMI) <17 kg/m2 or >45 kg/m2. Known history of renal or hepatic dysfunction, coagulation or bleeding disorder. Concurrent painful physical condition that may require analgesic treatment (such as long-term, consistent use of opioids) in the post-operative period for pain that is not strictly related to the surgery and which may confound the post-operative assessments based on the physician's discretion. Clinically significant medical disease that, in the opinion of the investigator, would make participation in a clinical study inappropriate. This includes any psychiatric or other conditions that would constitute a contraindication to participation in the study. 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. Resident of a skilled nursing facility (SNF), long-term acute care (LTAC) facility, inpatient rehabilitation facility (IRF), or nursing home. Participants from assisted living facilities will be eligible for the study. In addition, the subject may be withdrawn from the study if the subject meets the following criteria during the hospital stay: Any clinically significant event or condition uncovered during the surgery (e.g., excessive bleeding, acute sepsis) that might render the subject medically unstable or complicate the subject's post-operative course. Subjects who undergo hip fracture surgery more than 30 hours after admission to the Emergency Department.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FICB with EXPAREL<br>Group 1: Suprainguinal Fascia Iliaca Compartment Block (FICB) with EXPAREL and bupivacaine HCl | Drug: EXPAREL<br>* FICB with EXPAREL + Bupivacaine HCL (single dose)<br>Drug: Bupivacaine Hydrochloride<br>* FICB with EXPAREL + Bupivacaine HCL (Single dose)<br>|
| Active Comparator: FICB with Standard of Care: ropivacaine<br>Suprainguinal FICB with continuous infusion of local anesthetic (ropivacaine) via catheter placed in the FIC. | Drug: Ropivacaine<br>* FICB with continuous infusion of ropivacaine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary objective (total opioid consumption in morphine equivalents) | to compare total opioid consumption in morphine equivalents following FICB with EXPAREL +bupivacaine HCl to that following continuous infusion of ropivacaine via catheter, from end of FICB placement through 72 hours post-FICB, in subjects undergoing repair of intertrochanteric hip fracture To be measured as date, time, and dosage of all medication administered from the time ICF is signed to 72-hours post-surgery. | Through 72 hours post-FICB | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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EXPAREL, FICB, Fascia Iliaca Compartment Block, Ropivacaine