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Objective To compare pain outcome reports of patients undergoing hip or knee replacement who received single-injection nerve/plexus blocks with plain bupivacaine (BPV) with those of patients who received injections of buprenorphine-clonidine-dexamethasone (BCD) admixed with BPV. Design Prospective, parallel-arm, randomized, double-blind trial. Setting A single veterans' hospital. Subjects Ninety-eight veterans scheduled for total hip or knee replacement surgery with spinal as the primary anesthetic. Methods Participants were randomized to BPV-BCD or plain BPV groups. They underwent nerve/plexus blocks in the L2–L4 and L4–S3 distributions in advance of joint replacement surgery. The primary outcome was change in pain from baseline during the postoperative day, as assessed by the total pain score on the short-form McGill Pain Questionnaire-v2 (SF-MPQ-2). Secondary outcomes were pain during movement, pain interference, range of motion, mobility, and quality of recovery. Results On postoperative day one, the SF-MPQ-2 total score for the BPV-BCD group demonstrated greater pain reduction than that of the plain BPV group (mean difference 1.8 points, 95% confidence interval 0.6 to 3.0, P  = 0.003). The BPV-BCD group also had larger reductions in pain during movement in the surgical joint and less pain interference, along with increased range of hip and knee flexion, compared with the plain BPV group. Outcomes of mobility and quality of recovery were not different between groups. Conclusions Preoperative BPV-BCD blocks in the L2–L4 and L4–S3 nerve distributions for hip and knee replacements led to less pain on postoperative day one and increased knee and hip range of motion, compared with plain BPV blocks. Trial registration ClinicalTrials.gov ID NCT02891798. [ABSTRACT FROM AUTHOR]

The article informs about acute pain medicine hospital practices during the execution of military-funded clinical–translational research. Topics include encountered several complications related to regulatory processes and the changing practices of the hospital; and applied for funding for this project, single-injection nerve blocks with plain bupivacaine known to provide 15–20 hours of pain relief had used multimodal perineural analgesic with buprenorphine, clonidine, and dexamethasone.

Objective We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery. Design Prospective, parallel-arms, randomized, double-blind trial. Setting A single veterans' hospital. Subjects Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic. Methods Participants underwent nerve/plexus blocks at L2–L4 and L4–S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test. Results Significant (P  < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27). Conclusions BPV-BCD provided 26–39 hours of perineural analgesia in the L2–L4 and L4–S3 nerve distributions after hip/knee replacement surgery, compared with 11–21 hours for plain BPV. [ABSTRACT FROM AUTHOR]