| Eligibility |
Inclusion Criteria:
1. Male or female, 18 years of age and older at the Screening Visit.
2. Applies to female subjects only: Postmenopausal, surgically sterile, or willing to use
acceptable means of contraception for at least 30 days after surgery including any of
the following: hormonal contraceptives (e.g., oral, injectable, implantable starting
at least 30 days before study drug administration), effective double-barrier methods
(e.g., condoms with spermicide), intrauterine device, lifestyle with a personal choice
of abstinence, nonheterosexual lifestyle, or a strictly monogamous relationship with a
partner who has had a vasectomy.
3. Scheduled to undergo 2- or 3-column excisional hemorrhoidectomy under general
anesthesia using Milligan Morgan or Ferguson-type techniques, including modified
approaches with specialized instruments, such as LigaSure™ or harmonic scalpel, with a
cumulative incision length of a minimum 3 cm.
4. American Society of Anesthesiology (ASA) Physical Class 1-3.
5. Able and willing to comply with all study visits and procedures.
6. Able to speak, read, and understand the language of the Informed Consent Form (ICF),
study questionnaires, and other instruments used for collecting subject-reported
outcomes, in order to enable accurate and appropriate responses to pain scales and
other required study assessments.
7. Willing and capable of providing written informed consent.
Exclusion Criteria:
1. Pregnancy, nursing, or planning to become pregnant during the study or within one
month after study drug administration.
2. Use of any of the following medications within the times specified before surgery:
- Long-acting opioid medication within 3 days.
- Any opioid medication within 24 hours.
3. Concurrent painful physical condition that may require analgesic treatment in the
postoperative period for pain that is not surgically related and may confound the
postoperative assessments (e.g., rheumatoid arthritis, chronic neuropathic pain).
4. Single-column hemorrhoidectomy or hemorrhoidectomy without an internal component.
5. Body weight less than 50 kilograms (110 pounds).
6. History of hypersensitivity or idiosyncratic reactions to amide-type local anesthetics
or to opioid medication.
7. Contraindication to epinephrine, such as concurrent administration of monoamine
oxidase (MAO) inhibitors or antidepressants of amitriptyline or imipramine types,
conditions where the production or exacerbation of tachycardia could prove fatal
(e.g., poorly controlled thyrotoxicosis or severe heart disease), or any other
pathological conditions that might be aggravated by the effects of epinephrine.
8. Contraindications to any of the pain-control agents planned for postoperative use
(e.g., acetaminophen [paracetamol], oxycodone, morphine, ketorolac).
9. Administration of an investigational drug within 30 days or 5 elimination half-lives
of such investigational drug, whichever is longer, prior to study drug administration,
or planned administration of another investigational product or procedure during the
subject's participation in this study.
10. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription
medicine(s), or alcohol within the past 2 years.
11. Uncontrolled anxiety, schizophrenia, or other psychiatric disorder that, in the
opinion of the Investigator, may interfere with study assessments or compliance.
12. Significant medical conditions or laboratory results that, in the opinion of the
Investigator, indicate an increased vulnerability to study drugs and procedures, and
expose the subject to an unreasonable risk as a result of participating in this
clinical trial, such as: debilitating diseases, acute illnesses, hypotension, partial
or complete conduction block, impaired cardiac function, untreated hypertension,
advanced arteriosclerotic heart disease, cerebral vascular insufficiency, pre-existing
abnormal neurological or neuromuscular disease (e.g., epilepsy, myasthenia gravis),
advanced liver disease, severe renal impairment, advanced diabetes, comorbid
conditions associated with an immunocompromised status, such as blood dyscrasias,
HIV/AIDS, or recent chemotherapy.
In addition, the subject will be ineligible to receive study drug if he or she meets
the following criteria during surgery:
13. Any clinically significant event or condition uncovered during the surgery (e.g.,
excessive bleeding, acute sepsis) that might render the subject medically unstable or
complicate the subject's postoperative course.
14. A cumulative incision length less than 3 cm.
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