Efficacy and Safety of EXPAREL Versus Standard of Care (SoC) in Subjects Undergoing Elective Cesarean Section

Pain Management Clinical Trial

— CHOICE  

Official title:

A Multicenter, Randomized, Active-Controlled Study to Evaluate the Efficacy and Safety of EXPAREL When Administered Via Infiltration Into the Transversus Abdominis Plane Versus Standard of Care in Subjects Undergoing Elective Cesarean Section (CHOICE)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03853694
• Other study ID #: 402-C-414
• Status: Completed
• Phase: Phase 4
• Start date: March 4, 2019
• Est. completion date: January 16, 2020

Study information

• Verified date: July 2022
• Source: Pacira Pharmaceuticals, Inc
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to compare total opioid consumption by subjects in different treatment groups.

Another purpose of this study is to assess how well EXPAREL works, collect any safety data and assess your satisfaction using EXPAREL.

Description:

This is a Phase-4, multicenter, randomized, active-controlled study in approximately 182 adult women undergoing elective C-section. All subjects will remain in the hospital for up to 72 hours post surgery.

Subjects will be screened within 30 days prior to surgery. During the screening visit, subjects will be assessed for any past or present medical conditions that in the opinion of the investigator would preclude them from study participation.

After the Informed Consent Form (ICF) is signed, a medical history, surgical history, physical examination, 12-lead electrocardiogram (ECG), vital sign measurements, alcohol breath test and urine drug screen, and clinical laboratory tests (hematology and chemistry) will be performed.

On Day 1, prior to the C-section, eligible subjects will be randomized in a 1:1:1 ratio into one of the three treatment groups listed below:

• Group 1: 150 mcg Duramorph® (SOC arm)+ postoperative multi-modal pain regimen as defined in this protocol. No EXPAREL TAP infiltration following skin-incision closure.

• Group 2: 50 mcg Duramorph + EXPAREL TAP infiltration following skin-incision closure + postoperative multi-modal pain regimen as defined in this protocol.

• Group 3: EXPAREL TAP infiltration following skin-incision closure + postoperative multi-modal pain regimen as defined in this protocol. No Duramorph.

Rescue Medication will be provided, as needed, for all subjects.

Subjects will remain in the hospital for up to 72 hours after surgery.

Total opioid burden and Pain intensity scores using a 10 cm Visual Analog Scale (VAS) will be collected.

Daily pain intensity score (VAS) and all pain medications will be collected through Day 14.

A phone call will be made to each subject on Day 14 and Day 30.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 167
• Est. completion date: January 16, 2020
• Est. primary completion date: January 9, 2020
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Females 18 years of age and older at screening.

2. Term pregnancies of 37 to 42 weeks gestation, scheduled to undergo elective C-section.

3. American Society of Anesthesiology (ASA) physical status 1, 2, or 3.

4. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments.

Exclusion Criteria:

1. Subjects who, in the opinion of the study site principal investigator, have a high-risk pregnancy.

2. Subjects with a pregnancy-induced medical condition or complication.

3. Subjects with 3 or more prior C-sections.

4. Pre-pregnancy body mass index >50 kg/m2.

5. Allergy, hypersensitivity, intolerance, or contraindication to any of the study medications.

6. Planned concurrent surgical procedure with the exception of salpingo-oophorectomy or tubal ligation.

7. Severely impaired renal or hepatic function.

8. Subjects at an increased risk for bleeding or a coagulation disorder.

9. Concurrent painful physical condition that may require analgesic treatment in the postsurgical period for pain that is not strictly related to the surgery.

10. Clinically significant medical disease in either the mother or baby that, in the opinion of the investigator, would make participation in a clinical study inappropriate.

11. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years.

12. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug.

13. Previous participation in an EXPAREL study.

14. Any clinically significant event or condition uncovered during the surgery that might render the subject medically unstable or complicate the subject's postsurgical course.

15. Receives the epidural component of combined spinal epidural (CSE) anesthesia during the study.

Related Conditions & MeSH terms

• Elective Cesarean Section
• Pain Management

Intervention

Drug:
• 50 mcg Duramorph+ EXPAREL + multi-modal pain regimen
Intrathecal injection of 50 mcg Duramorph + EXPAREL administered via TAP infiltration + multi-modal pain regimen.
• 150 mcg Duramorph + multi-modal pain regimen
Intrathecal injection of 150 mcg Duramorph + multi-modal pain regimen.
• Exparel TAP + multi-modal pain regimen
EXPAREL administered via TAP infiltration + multi-modal pain regimen.

Locations

Country	Name	City	State
United States	Brigham and Women's Hospital	Boston	Massachusetts
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	Cleveland Clinic	Cleveland	Ohio
United States	Ohio State University	Columbus	Ohio
United States	Henry Ford Hospital	Detroit	Michigan
United States	Duke University Medical Center	Durham	North Carolina
United States	Inova Health System	Falls Church	Virginia
United States	University of Florida- Gainesville	Gainesville	Florida
United States	The University of Texas Medical Branch	Galveston	Texas
United States	Clinical Research Prime	Idaho Falls	Idaho
United States	University of Florida college of Medicine - Jacksonville	Jacksonville	Florida
United States	West Virginia University	Morgantown	West Virginia
United States	Robert Wood Johnson Medical School	New Brunswick	New Jersey
United States	St. Peter's University Medical Center	New Brunswick	New Jersey
United States	Columbia University Medical Center/NY Presbyterian Hospital	New York	New York
United States	Thomas Jefferson Medical Center	Philadelphia	Pennsylvania
United States	Magee-Women's Hospital of UPMC	Pittsburgh	Pennsylvania
United States	Stanford University School of Medicine	Stanford	California

Sponsors (1)

Lead Sponsor	Collaborator
Pacira Pharmaceuticals, Inc

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Total Postsurgical Opioid Consumption Through 72 Hours	To Compare total opioid consumption through 72 hours following EXPAREL infiltration into the Transversus abdominus plane (TAP) with SOC in subjects undergoing an elective C-section	Through 72 hours post-surgery
Secondary	Percentage of Opioid-free Subjects	Percentage of opioid-free subjects. LS Means probability from the logistic regression with treatment, site, age, and height as explanatory variables.	through 72 hours or hospital discharge, whichever came first
Secondary	Severity of Itching (Numeric Rating Scale Score)	Severity of itching (Numeric Rating Scale score from 0(being none)-10(being the worst))	through 72 hours after surgery
Secondary	Opioid Related Symptom Distress Scale Score (ORSDS)	The Opioid-Related Symptom Distress Scale (ORSDS) is a 4-point scale that evaluates 3 symptom distress dimensions (frequency, severity, bothersomeness) for 10 symptoms. The symptom-specific ORSDS is the average of the 3 symptom distress dimensions. The composite ORSDS is the average of 10 symptom-specific scores. Each question will receive a score from 0-4 the composite score for each subject is the average of all scores. A higher score indicates a worse outcome.	through 72 hours after surgery