Clinical Proposal for the Comparison of Intraperitoneal Anesthetic to Injected Local Anesthetic

NCT ID: NCT00508976

Last Updated: 2012-05-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-06-30

Study Completion Date

2008-04-30

Brief Summary

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The purpose of this study is to determine if pre-incisional lidocaine injection, instilled liquid bupivacaine, intra-abdominal aerosolized bupivacaine, or post-operative bupivacaine injection is superior in post-operative pain control in laparoscopic bariatric surgical patients.

Detailed Description

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The research objective is to compare our standard post-operative port site injection of 0.5% bupivacaine against pre-incisional port site injection of 1% lidocaine against the instillation of streamed bupivacaine 0.5% against the instillation of aerosolized 0.5% bupivacaine as it relates to post-operative analgesia usage and pain scale scores. The null hypothesis will be that there is no difference between the four arms of the study in regards to pain score and analgesia usage.

Conditions

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Pain, Postoperative Morbid Obesity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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3

Group Type EXPERIMENTAL

Streamed bupivacaine versus streamed normal saline

Intervention Type DRUG

Patients will receive 30ml of 0.9% normal saline divided equally and injected prior to port site incisions, then 10ml of 0.5% bupivacaine streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

2

Group Type EXPERIMENTAL

Injected lidocaine pre-incision vs saline pre-incision

Intervention Type DRUG

Patients will receive 30ml of 1% lidocaine divided equally and injected prior to port site incisions, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

4

Group Type EXPERIMENTAL

Aerosolized bupivacaine versus aerosolized saline

Intervention Type DRUG

Patients will receive 30 ml of 0.9% normal saline divided equally and injected prior to port site incision, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.5% bupivacaine aerosolized into coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

1

Group Type ACTIVE_COMPARATOR

Injected bupivacaine post-operatively

Intervention Type DRUG

Patients will receive 30 ml of 0.9% normal saline divided equally and injected prior to port site incision, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation, and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

Interventions

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Injected bupivacaine post-operatively

Patients will receive 30 ml of 0.9% normal saline divided equally and injected prior to port site incision, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation, and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

Intervention Type DRUG

Streamed bupivacaine versus streamed normal saline

Patients will receive 30ml of 0.9% normal saline divided equally and injected prior to port site incisions, then 10ml of 0.5% bupivacaine streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

Intervention Type DRUG

Aerosolized bupivacaine versus aerosolized saline

Patients will receive 30 ml of 0.9% normal saline divided equally and injected prior to port site incision, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.5% bupivacaine aerosolized into coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

Intervention Type DRUG

Injected lidocaine pre-incision vs saline pre-incision

Patients will receive 30ml of 1% lidocaine divided equally and injected prior to port site incisions, then 10ml of 0.9% normal saline streamed via port directed at operative field, then 10ml of 0.9% normal saline aerosolized into the coelomic cavity prior to deflation and our current standard of care, which is 30ml of 0.5% bupivacaine, divided equally between the five port-sites, injected at the end of the operation.

Intervention Type DRUG

Other Intervention Names

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bupivacaine bupivacaine marcaine normal saline bupivacaine marcaine normal saline aerosolized lidocaine normal saline pre-emptive

Eligibility Criteria

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Inclusion Criteria

1. Male and female patients between 18 and 65 years of age.
2. Patients undergoing elective bariatric surgery.

Exclusion Criteria

1. Patients allergic to bupivacaine or any other local anesthetics (amides \& esters).
2. Patients who have used opiates or opiods within 15 days prior to surgery.
3. Patients converted to open gastric bypass.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Pinnacle Health System

OTHER

Sponsor Role lead

Responsible Party

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Troy Moritz, D.O.

Troy Moritz DO

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Troy A Moritz, DO

Role: PRINCIPAL_INVESTIGATOR

Pinnacle Health; Community General Osteopathic Hospital

Locations

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Pinnacle Health; Community General Osteopathic Hospital

Harrisburg, Pennsylvania, United States

Site Status

Countries

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United States

References

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Aida S, Baba H, Yamakura T, Taga K, Fukuda S, Shimoji K. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999 Sep;89(3):711-6. doi: 10.1097/00000539-199909000-00034.

Reference Type BACKGROUND
PMID: 10475311 (View on PubMed)

Alkhamesi NA, Peck DH, Lomax D, Darzi AW. Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial. Surg Endosc. 2007 Apr;21(4):602-6. doi: 10.1007/s00464-006-9087-6. Epub 2006 Dec 16.

Reference Type BACKGROUND
PMID: 17180268 (View on PubMed)

Barczynski M, Konturek A, Herman RM. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc. 2006 Jul;20(7):1088-93. doi: 10.1007/s00464-005-0458-1. Epub 2006 May 13.

Reference Type BACKGROUND
PMID: 16703434 (View on PubMed)

Chou YJ, Ou YC, Lan KC, Jawan B, Chang SY, Kung FT. Preemptive analgesia installation during gynecologic laparoscopy: a randomized trial. J Minim Invasive Gynecol. 2005 Jul-Aug;12(4):330-5. doi: 10.1016/j.jmig.2005.05.005.

Reference Type BACKGROUND
PMID: 16036193 (View on PubMed)

Einarsson JI, Sun J, Orav J, Young AE. Local analgesia in laparoscopy: a randomized trial. Obstet Gynecol. 2004 Dec;104(6):1335-9. doi: 10.1097/01.AOG.0000146283.90934.fd.

Reference Type BACKGROUND
PMID: 15572499 (View on PubMed)

Fletcher D, Kayser V, Guilbaud G. Influence of timing of administration on the analgesic effect of bupivacaine infiltration in carrageenin-injected rats. Anesthesiology. 1996 May;84(5):1129-37. doi: 10.1097/00000542-199605000-00015.

Reference Type BACKGROUND
PMID: 8624007 (View on PubMed)

Huang SJ, Wang JJ, Ho ST, Liu HS, Liaw WJ, Li MJ, Liu YH. The preemptive effect of pre-incisional bupivacaine infiltration on postoperative analgesia following lower abdominal surgery under epidural anesthesia. Acta Anaesthesiol Sin. 1997 Jun;35(2):97-102.

Reference Type BACKGROUND
PMID: 9293650 (View on PubMed)

Ke RW, Portera SG, Bagous W, Lincoln SR. A randomized, double-blinded trial of preemptive analgesia in laparoscopy. Obstet Gynecol. 1998 Dec;92(6):972-5. doi: 10.1016/s0029-7844(98)00303-2.

Reference Type BACKGROUND
PMID: 9840560 (View on PubMed)

Kundu S, Achar S. Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician. 2002 Jul 1;66(1):99-102.

Reference Type BACKGROUND
PMID: 12126037 (View on PubMed)

Lam KW, Pun TC, Ng EH, Wong KS. Efficacy of preemptive analgesia for wound pain after laparoscopic operations in infertile women: a randomised, double-blind and placebo control study. BJOG. 2004 Apr;111(4):340-4. doi: 10.1111/j.1471-0528.2004.00083.x.

Reference Type BACKGROUND
PMID: 15008770 (View on PubMed)

Lohsiriwat V, Lert-akyamanee N, Rushatamukayanunt W. Efficacy of pre-incisional bupivacaine infiltration on postoperative pain relief after appendectomy: prospective double-blind randomized trial. World J Surg. 2004 Oct;28(10):947-50. doi: 10.1007/s00268-004-7471-8. Epub 2004 Sep 29.

Reference Type BACKGROUND
PMID: 15573244 (View on PubMed)

Jiranantarat V, Rushatamukayanunt W, Lert-akyamanee N, Sirijearanai R, Piromrat I, Suwannanonda P, Muangkasem J. Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy. J Med Assoc Thai. 2002 Sep;85 Suppl 3:S897-903.

Reference Type BACKGROUND
PMID: 12452227 (View on PubMed)

Maestroni U, Sortini D, Devito C, Pour Morad Kohan Brunaldi F, Anania G, Pavanelli L, Pasqualucci A, Donini A. A new method of preemptive analgesia in laparoscopic cholecystectomy. Surg Endosc. 2002 Sep;16(9):1336-40. doi: 10.1007/s00464-001-9181-8. Epub 2002 May 7.

Reference Type BACKGROUND
PMID: 11988800 (View on PubMed)

Mixter CG 3rd, Hackett TR. Preemptive analgesia in the laparoscopic patient. Surg Endosc. 1997 Apr;11(4):351-3. doi: 10.1007/s004649900361.

Reference Type BACKGROUND
PMID: 9094275 (View on PubMed)

Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002 Mar;96(3):725-41. doi: 10.1097/00000542-200203000-00032. No abstract available.

Reference Type BACKGROUND
PMID: 11873051 (View on PubMed)

Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999 May;13(5):445-8. doi: 10.1007/s004649901011.

Reference Type BACKGROUND
PMID: 10227938 (View on PubMed)

Mouton WG, Bessell JR, Pfitzner J, Dymock RB, Brealey J, Maddern GJ. A randomized controlled trial to determine the effects of humidified carbon dioxide insufflation during thoracoscopy. Surg Endosc. 1999 Apr;13(4):382-5. doi: 10.1007/s004649900994.

Reference Type BACKGROUND
PMID: 10094752 (View on PubMed)

Mouton WG, Bessell JR, Millard SH, Baxter PS, Maddern GJ. A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery. Surg Endosc. 1999 Feb;13(2):106-8. doi: 10.1007/s004649900915.

Reference Type BACKGROUND
PMID: 9918607 (View on PubMed)

Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005 Mar;100(3):757-773. doi: 10.1213/01.ANE.0000144428.98767.0E.

Reference Type BACKGROUND
PMID: 15728066 (View on PubMed)

Other Identifiers

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PHH#07-005

Identifier Type: -

Identifier Source: org_study_id

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