PECS Block vs. Multimodal Analgesia for Prevention of Persistent Postoperative Pain in Breast Surgery

NCT ID: NCT03084536

Last Updated: 2024-12-24

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

View full results

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

134 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-07

Study Completion Date

2021-02-25

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

In this double blinded randomized placebo-controlled trial, 160 subjects scheduled for breast surgery involving the axilla will be administered a multimodal pain regimen including acetaminophen, dexamethasone, celecoxib, and gabapentin. 80 subjects will also receive a Pectoral Nerve blocks I and II (PECS I and II block) preoperatively.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Breast Cancer Breast Cancer Female Cancer of Breast

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Preoperative PECS blocks

* PECS I \& II block will be administered preoperatively
* For unilateral surgeries, a PECS I block will be performed with 0.15mL/kg of 0.375% bupivacaine (maximum 10mL). The PECS II block will be performed with 0.3 mL/kg of the same solution (maximum 20mL). If there is a contralateral surgery (simple mastectomy) a PECS II block will also be performed on the other side with 0.2mL/kg of 0.375% bupivacaine (maximum 20mL)
* To ensure blind integrity, study drug syringes will be marked only "study drug" and subject number
* Perioperative analgesic will be encouraged.. Gabapentin 300mg, celecoxib 200mg and acetaminophen 1000mg will be administered to all patients following arrival to the preoperative area. All patients will receive premedication of 1-2 mg midazolam IV (age \< 65) and 50-100 μg fentanyl IV prior to the block placement or entry to the operating room at the discretion of the regional team or operating room anesthesiologist

Group Type ACTIVE_COMPARATOR

Bupivacaine

Intervention Type DRUG

-Given after general anesthesia

Gabapentin

Intervention Type DRUG

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.

Celecoxib

Intervention Type DRUG

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.
* Naproxen will be substituted for celecoxib in patients with sulfa allergies.

Acetaminophen

Intervention Type DRUG

-As per routine care

Midazolam

Intervention Type DRUG

-As per routine care

Fentanyl

Intervention Type DRUG

-As per routine care

Placebo PECS blocks

* A sham block (normal saline) will be placed preoperatively
* To ensure blind integrity, study drug syringes will be marked only "study drug" and subject number.
* Perioperative analgesic regimen will be encouraged. Gabapentin 300mg, celecoxib 200mg and acetaminophen 1000mg will be administered to all patients following arrival to the preoperative holding area. On the day of surgery all patients will receive premedication of 1-2 mg midazolam IV (age \< 65) and 50-100 μg fentanyl IV prior to the block placement or entry to the operating room at the discretion of the regional team or operating room anesthesiologist.

Group Type PLACEBO_COMPARATOR

Gabapentin

Intervention Type DRUG

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.

Celecoxib

Intervention Type DRUG

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.
* Naproxen will be substituted for celecoxib in patients with sulfa allergies.

Acetaminophen

Intervention Type DRUG

-As per routine care

Midazolam

Intervention Type DRUG

-As per routine care

Fentanyl

Intervention Type DRUG

-As per routine care

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Bupivacaine

-Given after general anesthesia

Intervention Type DRUG

Gabapentin

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.

Intervention Type DRUG

Celecoxib

* As per routine care
* Will not be prescribed for any patient with preexisting kidney disease or ≥ 65 years.
* Naproxen will be substituted for celecoxib in patients with sulfa allergies.

Intervention Type DRUG

Acetaminophen

-As per routine care

Intervention Type DRUG

Midazolam

-As per routine care

Intervention Type DRUG

Fentanyl

-As per routine care

Intervention Type DRUG

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Bupivacaine hydrochloride

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Scheduled to undergo elective breast cancer surgeries at Barnes-Jewish Hospital:

* unilateral axillary dissection
* unilateral modified radical mastectomy
* mastectomy with same day unilateral reconstruction
* unilateral sentinel lymph node biopsy (SLNB)
* partial mastectomy with unilateral SLNB
* simple mastectomy with unilateral SLNB
* At least 18 years of age.
* Able to understand and willing to sign an Institutional Review Board (IRB)-approved written informed consent document.
* Enrollment in the SATISFY-SOS study (WUSTL IRB# 201203088, NCT02032030).

Exclusion Criteria

* Planned for bilateral axillary or bilateral reconstruction surgery.
* Previous surgery on the surgical breast and/or axilla with the exception of partial mastectomy or sentinel lymph node biopsy
* Pre-existing pain in the axilla affecting the ability to use extremity for activities of daily living or requiring medication for treatment.
* Current or past medical history of liver disease or cirrhosis with an elevated INR \>1.4 or currently elevated transaminase levels.
* Known contraindications to peripheral nerve block placement.
* Pregnant or breastfeeding.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition
* Planned additional surgery to the surgical breast or axilla in the next year (exception would be minor surgery to breast but not axilla such as simple tissue expander replacement or lumpectomy)
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Ryan C Guffey, M.D.

Role: PRINCIPAL_INVESTIGATOR

Washington University School of Medicine

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

Access external resources that provide additional context or updates about the study.

http://www.siteman.wustl.edu

Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

201703053

Identifier Type: -

Identifier Source: org_study_id