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NCT Number: NCT07665762

Liposomal Bupivacaine Plus Plain Bupivacaine Versus Dexamethasone Plus Plain Bupivacaine in the Supraclavicular Brachial Plexus Block in Patients With Risk Factors for Severe Acute Postoperative Pain

The supraclavicular brachial plexus block (BPB) is a frequently used anaesthetic method for upper limb surgeries, including distal radial fracture surgery. Adding liposomal bupivacaine to BPB has shown promise in enhancing postoperative pain control. A previous randomized controlled trial demonstrated that it reduced pain scores and OBAS compared to plain bupivacaine alone, especially on postoperative day (POD) 1. Adding adjuncts to non-liposomal local anaesthetics can also enhance and prolong postoperative pain relief. The effectiveness of liposomal bupivacaine compared to adjuncts like dexamethasone and dexmedetomidine remains unclear. Since liposomal bupivacaine is more expensive, it is crucial to compare its analgesic efficacy with these alternatives. A randomized controlled trial comparing liposomal bupivacaine versus dexamethasone in the interscalene BPB for shoulder surgery found that liposomal bupivacaine resulted in statistically significantly lower pain scores and less pain interference in the Brief Pain Inventory, although the reduction was not considered clinically relevant. Its high cost may therefore limit its routine use unless specific clinical contexts where its efficacy is maximized are identified. Notably, patients with risk factors like psychological factors, preoperative pain, and prior analgesic use may benefit most from its application.

A randomized controlled trial to compare the analgesic efficacy of liposomal bupivacaine plus plain bupivacaine versus dexamethasone plus plain bupivacaine in supraclavicular BPB for patients at higher risk of poor acute pain control post distal radial fracture surgery will be conducted. Patients with severe preoperative pain, opioid use, depressive symptoms, anxiety symptoms, and/or higher energy and high-grade fracture cases will be selected. The primary outcome measured is the intensity of acute postoperative pain with movement in the first 48 hours after surgery. Important secondary outcomes include pain intensity at rest, opioid consumption, OBAS scores, chronic pain, and upper limb functionality.

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Key information

Conditions

Pain, Postoperative Dexamethasone Distal Radial Fracture High Risk Factors Liposomal Bupivacaine Neurologic Manifestations Pain Pathologic Processes Pathological Conditions, Signs and Symptoms Postoperative Complications Signs and Symptoms Supraclavicular Brachial Plexus Block

Age range

18 year–90 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • American Society of Anesthesiologist (ASA) status I-III
  • Age 18-90 years old
  • Scheduled for distal radial fracture fixation (Open reduction and internal fixation with volar approaching locking plate)
  • Informed consent obtained
  • Patients identified to be at an elevated risk of suffering from poor postoperative pain control. Patients with one or more of the following risk factors:
  • Severe preoperative pain: defined as worse numerical rating scale (NRS) pain score equal or higher than 6/10 with arm movements at day before surgery.
  • Preoperative use of opioid: use of strong opioids such as morphine, oxycodone
  • Depressive symptoms: Patient health questionnaire (PHQ-9) score of 10 or above
  • Anxiety symptoms: General Anxiety Disorder (GAD-7) score of 10 or above
  • Higher energy and high-grade fracture cases - road traffic accident, fall from height, open fractures, combined distal radius and distal ulna fractures, fractures requiring external fixation, fractures with severe articular comminution or severe metaphyseal extension, comminuted fractures requiring more than a single volar approach incision and a single volar locking plate implant

Exclusion criteria

  • Revision surgery
  • Previous fractures or surgery in the affected distal radius
  • Surgery involving more than the affected arm
  • Cases with baseline (pre-injury) QuickDASH score worse (higher) than 10 out of 100
  • Respiratory compromise (requires long term oxygen)
  • History of seizures
  • Pre-existing neurological disorder/deficit
  • Alcohol or substance abuse
  • Impaired mental state
  • Local infection
  • Allergy to analgesic drugs: local anaesthetic drugs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids
  • Impaired renal function (defined as effective glomerular filtration rate < 30ml/min/1.73m2
  • Impaired liver function (defined as plasma bilirubin over 34μmol/L; international normalized ratio [INR] ≥1.7, alanine aminotransferase [ALT] over 100U/L, aspartate aminotransferase [AST] over 100U/L)
  • Coagulopathy (platelet count <100,000/ml and/or INR ≥ 1.5) or the use of anticoagulants (not including aspirin) that precludes the use of supraclavicular BPB
  • Pregnancy
  • Patient refusal for regional nerve blocks
  • Patient refusal to join the clinical trial
  • Patient unable/unwilling to attend post-op rehabilitation programme

Treatment and study plan

10ml 0.5% plain bupivacaine with 10ml 1.33% liposomal bupivacaine

Drug

10ml 0.5% plain bupivacaine plus 10ml 1.33% liposomal bupivacaine (133mg)

19ml 0.5% plain bupivacaine with 1ml (4mg) dexamethasone

Drug

19ml 0.5% plain bupivacaine plus 1ml (4mg) dexamethasone

Primary outcomes

  1. Weighted area under curve (AUC) pain score with movement

    Time frame: The first 48 hours after surgery

    The weighted area under curve (AUC) numerical rating scale (NRS) pain score with movement (active wrist flexion and extension) from 0-48 hours after distal radial fracture surgery.

Secondary outcomes

  1. NRS pain scores

    Time frame: Postoperative day 0-7

    NRS pain scores both at rest and with movement will be assessed from after surgery to POD 7. (NRS scale 0-10, where 0 is no pain, and 10 is the worst possible pain)

  2. Overall Benefit of Analgesic Score (OBAS)

    Time frame: Postoperative day 0-7

    Overall Benefit of Analgesic Score (OBAS) will be assessed once a day until POD 7 (range, 0 [best] to 28 [worst]).

  3. Acute postoperative opioid consumption

    Time frame: Postoperative day0-7

    The daily consumption of oxycodone in the ward and after discharge will be recorded. The dose of rescue intravenous morphine consumption in the PACU will also be recorded.

  4. Sleep disturbance

    Time frame: Postoperative day0-7

    Sleep disturbance due to pain will be evaluated once a day till POD 7 (0-10, where 0 represents no disturbance and 10 represents the most disturbance possible).

  5. Quality of recovery (QoR)

    Time frame: Postoperative day0-7

    This will be accessed using the Quality of recovery (QoR) questionnaire. (range from 0 to 18, where 0 represent the worst quality of recovery and 18 represent the best quality of recovery)

  6. Adverse effects related to supraclavicular BPB

    Time frame: postoperative day0-2

    The potential side effects related to the supraclavicular BPB will be recorded.

  7. Opioid related side effects

    Time frame: postoperative day0-7

    Opioid related side effects will be recorded.

  8. Analgesic block duration.

    Time frame: On postoperative day1

    Time to return of pain, time to sensory resolution, time to motor resolution will be recorded on POD 1.

  9. Sensory and motor assessment of the affected upper limb

    Time frame: Postoperative day0-1

    Sensation to pin prick will be tested over the following areas: C5 (lateral shoulder), C6 (thumb), C7 (3rd finger), and C8 (4th finger) dermatomes. Motor assessment will be done by recording grip strength and bicep contraction. Sensation will be rated as 0-10 , where 0 represent no sensation and 10 represent normal sensation. Motor function will be rated as 0 (paralysis), 1 (paresis), 2 (normal power).

  10. Health related quality of life

    Time frame: Baseline and at 3, 6 and 12 weeks after surgery

    Health related quality of life will be assessed using the SF-12v2. Baseline scores will be obtained before surgery. The SF-12v2 will produce two summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Both summary scores range from 0 to 100, where higher scores always indicate better physical and mental health.

  11. Upper limb functional scores.

    Time frame: Baseline and at 3, 6 and 12 weeks after surgery

    The validated Chinese versions of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) will be used to assess upper limb functional scores. Baseline scores will be obtained before surgery. (Range from 0 to 100, a lower score indicates a better outcome)

  12. Hand grip power of normal and injured side

    Time frame: At 3, 6 and 12 weeks after surgery

    Hand grip power of normal and injured side will be assessed (both hands).

Study contacts

Contact information is provided by the study sponsor or research team.

Stanley S.C. Wong

CONTACT

[email protected]

(852) 2255 3303

Sponsors and collaborators

Lead sponsor

The University of Hong Kong

Other

Registry information

Official study title

Liposomal Bupivacaine Plus Plain Bupivacaine Versus Dexamethasone Plus Plain Bupivacaine in the Supraclavicular Brachial Plexus Block in Patients With Risk Factors for Severe Acute Postoperative Pain: a Randomized Controlled Trial

Important dates

Study start
2026
Primary completion
2028
Study completion
2029
First posted
Jun 24, 2026
Registry last updated
Jun 24, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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