{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:12:56Z","timestamp":1789035176547,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Department of Defense, United States","award":["W81XWH-15-1-0294"],"award-info":[{"award-number":["W81XWH-15-1-0294"]}]},{"name":"Office of the Assistant Secretary of Defense for Health Affairs","award":["FY14 DoD"],"award-info":[{"award-number":["FY14 DoD"]}]},{"name":"USAMRMC Broad Agency","award":["W81XWH-15-1-0294"],"award-info":[{"award-number":["W81XWH-15-1-0294"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective, parallel-arms, randomized, double-blind trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A single veterans\u2019 hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants underwent nerve\/plexus blocks at L2\u2013L4 and L4\u2013S3 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Significant (P\u2009&amp;lt;\u20090.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N\u2009=\u200962) vs plain BPV (N\u2009=\u200916). The time until start of postoperative pain was 26 vs 11\u2009hours (mean difference = 15\u2009hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15\u2009hours (mean difference = 17\u2009hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21\u2009hours (mean difference = 16\u2009hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20\u2009hours (mean difference = 19\u2009hours, 95% CI = 11 to 27).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>BPV-BCD provided 26\u201339\u2009hours of perineural analgesia in the L2\u2013L4 and L4\u2013S3 nerve distributions after hip\/knee replacement surgery, compared with 11\u201321\u2009hours for plain BPV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnaa229","type":"journal-article","created":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T11:32:04Z","timestamp":1591788724000},"page":"2893-2902","source":"Crossref","is-referenced-by-count":16,"title":["Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine: Preliminary Report from a Randomized Clinical Trial"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5290-121X","authenticated-orcid":false,"given":"Brian A","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W","family":"Ibinson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsha E","family":"Ritter","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalin S","family":"Ezaru","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hulimangala R","family":"Rakesh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry J","family":"Paiste","sequence":"additional","affiliation":[{"name":"Foundation for Anesthesia Education and Research (FAER), Schaumburg, Illinois"},{"name":"University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Veterans Research Foundation of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M","family":"Mikolic","sequence":"additional","affiliation":[{"name":"StatCore, Veterans Research Foundation of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Visala S","family":"Muluk","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"IMPACT Clinic, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara R","family":"Piva","sequence":"additional","affiliation":[{"name":"Physical Therapy\u2013Clinical Translational Research 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