Analgesia, Postoperative Clinical Trial
Official title:
Exparel vs. Bupivacaine Hydrochloride vs. Placebo for Transversus Abdominis Plane Blocks During Open Retromuscular Hernia Repair
Verified date | September 2021 |
Source | The Cleveland Clinic |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Patients usually experience some level of pain after their hernia repair. To control pain after the operation, surgeons have many options. One of them is to make some injections of pain blocker medications into the nerves that are responsible for the sensations the abdominal wall.This procedure is called TAP block (transversus abdominis place block). These medications are called local anesthetics, and there is a variety of medications that can be used. One of such medications is called Exparel® (Liposomal Bupivacaine). Exparel® has the potential benefit of lasting more hours than regular anesthetics. Although this drug is being used with increasing frequency, the investigators do not have good quality studies investigating the benefits of using this medication during a hernia repair, especially when compared to other types of local anesthetics (Bupivacaine Hydrochloride) or when compared to not injecting this medication at all. This study aim to investigate if Exparel®, when injected in the nerves of the abdominal wall during hernia repair can: (1) reduce the dose of additional opioid medications (morphine and similar) needed to achieve good pain control and (2) result in lower pain scores. The hypothesis is that Exparel® will result in a 30% decrease in the total requirements for opioid medications during the first 72 hours after surgery. Patients will be randomized to receive either Exparel®+Bupivacaine Hydrochloride, Bupivacaine Hydrochloride or Placebo (normal saline) during the operation through a TAP block. All patients will receive a patient controlled analgesia device after the operation, where patients can simply push a button every time they feel pain and the device will administer a dose of opioid medications. The investigators of the study will record the necessary amount of opioids used by the patients to achieve good pain control and also record pain scores several times during hospital stay.
Status | Completed |
Enrollment | 164 |
Est. completion date | December 19, 2019 |
Est. primary completion date | December 19, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patients with Primary Ventral or Incisional Hernias - Scheduled to undergo hernia repair through an open approach - Hernia repair performed in an elective setting - Hernia repair performed through a midline incision - Hernia repair performed in a clean wound - Hernia repair performed with mesh placed in the retromuscular position Exclusion Criteria: - patients with less than 18 years old of age - patients scheduled to undergo a minimally invasive hernia repair - patients where hernia repair is planned to be performed with mesh placement in a different position than retromuscular - patient undergoing hernia repair with a clean-contaminated, contaminated or infected wound - patients undergoing hernia repair in an non-elective fashion - patients with allergy, hypersensitivity or contraindication to bupivacaine - patients with history of chronic liver disease with moderate or severe impairment in liver function defined as a Child-Pugh class B or C - patients with chronic kidney disease on dialysis - chronic opioid users, defined as daily or near daily use of opioids for at least 90 days in the past year - patients unable to provide informed written consent |
Country | Name | City | State |
---|---|---|---|
United States | Cleveland Clinic Comprehensive Hernia Center | Cleveland | Ohio |
Lead Sponsor | Collaborator |
---|---|
The Cleveland Clinic | Pacira Pharmaceuticals, Inc |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Cumulative Opioid Requirements for 72 Hours After Surgery | Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. The cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparations will be recorded. Such assessment will be performed at the 3rd postoperative day (72 hours of operation). | Measured from end of surgery until 72 hours after the surgery | |
Primary | Cumulative Opioid Requirements at Postoperative Day 0 | Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. The cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparation will be measured at postoperative day 0 (day of surgery). | From end of surgery until the end of postoperative day 0 (23:59pm of postoperative day 0) | |
Primary | Cumulative Opioid Requirements at Postoperative Day 1 | Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. Cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparations, measured at postoperative day 1 | From 00:00am of postoperative day 1 until (23:59pm of postoperative day 1) | |
Primary | Cumulative Opioid Requirements at Postoperative Day 2 | Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. Cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparations, measured at postoperative day 2 | From 00:00 of postoperative day 2 until 23:59pm of postoperative day 2 | |
Primary | Cumulative Opioid Requirements at Postoperative Day 3 | Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. Cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparations, measured at postoperative day 3 | From 00:00 of postoperative day 3 until 23:59pm of postoperative day 3 | |
Secondary | Opioid Requirements for Total Length of Hospital Stay | Cumulative dose of opioids administered intravenously (infused through a patient-controlled analgesia device as well as the quantity of opioids administered intravenously as rescue, if needed) and the quantity of opioids administered through oral preparations administered during the entire length of hospital stay. Measured in milligrams or micrograms as appropriate and converted to oral morphine equivalent daily dose. | Measured from end of surgery until the time of hospital discharge, up to a maximum of 6 days | |
Secondary | Pain Scores at Postoperative Day 0 | Measured using a 100mm Visual Analog Scale, at the end of the first of postoperative day 0 (day of surgery).
The scale ranges from 0mm (No pain) to 100mm (Pain as bad as it could possibly be). A paper-based version of the VAS will be used, containing a 100mm line, where the left-end (0mm) contains the sentence "No Pain" and in the right-end (100mm) contains the sentence "Pain as bad as it could possibly be". Patients will be asked to indicate on the line where the pain is in relation to the two extremes. This will be performed with a pen. Measure with a ruler will be performed from the left hand side to the mark and this will be recorded in mm. Lower values represent less pain and higher values represent more pain. There are no subscale components for this measurement. |
Measured once, from end of surgery until the end of postoperative day 0 (23:59pm of the day of surgery) | |
Secondary | Pain Scores at Postoperative Day 1 | Measured using a 100mm Visual Analog Scale, at the end of the postoperative day 1.
The scale ranges from 0mm (No pain) to 100mm (Pain as bad as it could possibly be). A paper-based version of the VAS will be used, containing a 100mm line, where the left-end (0mm) contains the sentence "No Pain" and in the right-end (100mm) contains the sentence "Pain as bad as it could possibly be". Patients will be asked to indicate on the line where the pain is in relation to the two extremes. This will be performed with a pen. Measure with a ruler will be performed from the left hand side to the mark and this will be recorded in mm. Lower values represent less pain and higher values represent more pain. There are no subscale components for this measurement. |
Measured once, from 00:00am of postoperative day 1 until the end of postoperative day 1 (23:59pm of postoperative day 1) | |
Secondary | Pain Scores at Postoperative Day 2 | Measured using a 100mm Visual Analog Scale, at the end of the postoperative day 2 The scale ranges from 0mm (No pain) to 100mm (Pain as bad as it could possibly be). A paper-based version of the VAS will be used, containing a 100mm line, where the left-end (0mm) contains the sentence "No Pain" and in the right-end (100mm) contains the sentence "Pain as bad as it could possibly be". Patients will be asked to indicate on the line where the pain is in relation to the two extremes. This will be performed with a pen. Measure with a ruler will be performed from the left hand side to the mark and this will be recorded in mm. Lower values represent less pain and higher values represent more pain. There are no subscale components for this measurement. | Measured once, from 00:00am of postoperative day 2 until the end of postoperative day 2 (23:59pm of postoperative day 2) | |
Secondary | Pain Scores at Postoperative Day 3 | Measured using a 100mm Visual Analog Scale, at the end of the postoperative day 3 The scale ranges from 0mm (No pain) to 100mm (Pain as bad as it could possibly be). A paper-based version of the VAS will be used, containing a 100mm line, where the left-end (0mm) contains the sentence "No Pain" and in the right-end (100mm) contains the sentence "Pain as bad as it could possibly be". Patients will be asked to indicate on the line where the pain is in relation to the two extremes. This will be performed with a pen. Measure with a ruler will be performed from the left hand side to the mark and this will be recorded in mm. Lower values represent less pain and higher values represent more pain. There are no subscale components for this measurement. | Measured once, from 00:00am of postoperative day 3 until the end of postoperative day 3 (23:59pm of postoperative day 3) | |
Secondary | Length of Hospital Stay | Measured in days, being the difference from day of surgery until the day of hospital discharge.
The scale ranges from 0mm (No pain) to 100mm (Pain as bad as it could possibly be). A paper-based version of the VAS will be used, containing a 100mm line, where the left-end (0mm) contains the sentence "No Pain" and in the right-end (100mm) contains the sentence "Pain as bad as it could possibly be". Patients will be asked to indicate on the line where the pain is in relation to the two extremes. This will be performed with a pen. Measure with a ruler will be performed from the left hand side to the mark and this will be recorded in mm. Lower values represent less pain and higher values represent more pain. There are no subscale components for this measurement. |
From the day of surgery until the day of hospital discharge, up to a maximum of 30 days | |
Secondary | 30-day Pain Scores | Measured using the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity 3a survey. This survey has 3 questions:(1) How intense was your pain as its worst? (2) How intense was your average pain? and (3) What is your level of pain right now?. Each question has 5 response options ranging in value from 1 to 5. To find the total raw score, sum of the values for each question is performed; lowest possible raw score is 3 and highest possible raw score is 15.A raw score of 10 converts to a T-score of 54.5 with a standard error (SE) of 2.9. Thus, the 95% confidence interval around the observed score ranges from 48.8 to 54.5 (T-score + (1.96*SE) or 54.5 + (1.96*2.9). A score of 50 is the average for the United States general population with a standard deviation of 10. For negatively-worded concepts like Pain Intensity, a T-score of 60 is one SD worse than average. By comparison, a Pain Intensity Tscore of 40 is one SD better than average. | Measured during the 30-day follow-up visit, expected to occur 30-days after the day of surgery, up to a maximum of 90 days | |
Secondary | 30-day Patient-Reported Quality of Life | Measured using the Hernia Related Quality of Life survey (HerQLes) during the 30-day follow-up visit. The HerQLes is a valid and reliable hernia-specific quality of life measure. Each questions has 6 response options ranging in value from one to six. To find the raw score for the HerQles, a sum of the values of the response to each question is performed. For example, the lowest possible score is 12; the highest possible score is 72. All questions must be answered to provide a valid score. Mean and standard deviations of the scores of the entire study population will be calculated. Next, the Z score will be calculated as follows:
(Raw score-mean) / Standard Deviation. Next step is to calculate the Standard Score, as follows: (-(Z score)*Mean)+Standard Deviation. The standard score will be used for comparisons and reports, and should provide a value ranging from 0 to 100. Lower scores means lower quality of life and higher scores means higher quality of life. |
Measured during the 30-day follow-up visit, expected to occur 30-days after the day of surgery, up to a maximum of 90 days |
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