Standard Bupivacaine vs Liposomal Bupivacaine in Colorectal Patients

NCT ID: NCT03638635

Last Updated: 2019-09-09

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

63 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-14

Study Completion Date

2019-01-16

Brief Summary

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The transversus abdominis plane (TAP) block can be used to reduce pain in patients who get abdominal surgery. TAP blocks are given with a local anesthetic. The purpose of this study is to compare pain medication usage after surgery between two different types of local anesthetic: liposomal bupivacaine and standard bupivacaine.

Detailed Description

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Pain control is a factor that is central to the surgical patient's postoperative experience. Opioid pain medications are a mainstay of postoperative pain management. However, these have several adverse effects.

Multimodal pain regimens to minimize opioid use have become central to enhanced recovery after surgery (ERAS) protocols. The transversus abdominis plane (TAP) block is one intervention that contributes to this regimen. Traditionally, TAP blocks are performed with local anesthetics such as bupivacaine. More recently, these have also been performed with liposomal bupivacaine, whose duration of action is much greater than regular bupivacaine (96 hours versus 8-9 hours, respectively).

In this study, postoperative opioid usage will be compared between patients receiving regular bupivacaine and liposomal bupivacaine.

Conditions

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Opioid Use Pain, Postoperative Colectomy Colorectal Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants are randomized to receive either standard bupivacaine or liposomal bupivacaine.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The participant and the floor nursing staff recording pain scores will be blinded to the assigned intervention.

Study Groups

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Standard Bupivacaine

Standard (0.25% bupivacaine) bupivacaine (133 mg in 10mL, diluted with 20 mL saline) will be injected into the fascial layer between the internal oblique and the transversus abdominis with ultrasound guidance, 30 mL per side for a total of 60 mL.

Group Type ACTIVE_COMPARATOR

Bupivacaine

Intervention Type DRUG

Abdominal injection of bupivacaine into fascial layer.

Bupivacaine Liposome

Liposomal bupivacaine (133 mg in 10mL, diluted with 20 mL saline) will be injected into the fascial layer between the internal oblique and the transversus abdominis with ultrasound guidance, 30 mL per side for a total of 60 mL.

Group Type EXPERIMENTAL

Bupivacaine liposome

Intervention Type DRUG

Abdominal injection of bupivacaine liposome into fascial layer.

Interventions

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Bupivacaine

Abdominal injection of bupivacaine into fascial layer.

Intervention Type DRUG

Bupivacaine liposome

Abdominal injection of bupivacaine liposome into fascial layer.

Intervention Type DRUG

Other Intervention Names

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Marcaine Exparel

Eligibility Criteria

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Inclusion Criteria

* 18 years of age or older
* Undergoing elective colectomy by surgeons of Fairfax Colon and Rectal Surgery

Exclusion Criteria

* Allergic to local anesthetics
* Unable to provide consent
* Pregnant
* On opioids at home chronically (Patients previously on a regular opioid regimen would need to be opioid-free for a period of 1 year for inclusion in the study)
* Undergoing emergent operations
* Undergoing loop ileostomy reversal
* Undergoing abdominoperineal resection, pelvic exenteration, or perineal rectal prolapse repairs
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Inova Health Care Services

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Donald Colvin, MD

Role: PRINCIPAL_INVESTIGATOR

Inova Health Care System

Locations

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Fairfax Colon & Rectal Surgery, Alexandria Office

Alexandria, Virginia, United States

Site Status

Fairfax Colon & Rectal Surgery, Fairfax-Prosperity Office

Fairfax, Virginia, United States

Site Status

Fairfax Colon & Rectal Surgery, Fair Oaks Office

Fairfax, Virginia, United States

Site Status

Inova Fairfax Medical Campus

Falls Church, Virginia, United States

Site Status

Fairfax Colon & Rectal Surgery, Loudoun Office

Lansdowne Town Center, Virginia, United States

Site Status

Fairfax Colon & Rectal Surgery, Reston Office

Reston, Virginia, United States

Site Status

Countries

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United States

References

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Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001 Oct;56(10):1024-6. doi: 10.1046/j.1365-2044.2001.02279-40.x. No abstract available.

Reference Type BACKGROUND
PMID: 11576144 (View on PubMed)

Young MJ, Gorlin AW, Modest VE, Quraishi SA. Clinical implications of the transversus abdominis plane block in adults. Anesthesiol Res Pract. 2012;2012:731645. doi: 10.1155/2012/731645. Epub 2012 Jan 19.

Reference Type BACKGROUND
PMID: 22312327 (View on PubMed)

Rashid A, Gorissen KJ, Ris F, Gosselink MP, Shorthouse JR, Smith AD, Pandit JJ, Lindsey I, Crabtree NA. No benefit of ultrasound-guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in elective laparoscopic colonic surgery: results of a double-blind randomized controlled trial. Colorectal Dis. 2017 Jul;19(7):681-689. doi: 10.1111/codi.13578.

Reference Type BACKGROUND
PMID: 27943522 (View on PubMed)

Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, Oh JH, Park JW, Park B, Kim DH. Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer: a double-blind randomized controlled trial. Surg Endosc. 2017 Jan;31(1):127-134. doi: 10.1007/s00464-016-4941-7. Epub 2016 Apr 29.

Reference Type BACKGROUND
PMID: 27129571 (View on PubMed)

Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, Acheson AG. A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013 Jul;27(7):2366-72. doi: 10.1007/s00464-013-2791-0. Epub 2013 Feb 7.

Reference Type BACKGROUND
PMID: 23389068 (View on PubMed)

Favuzza J, Delaney CP. Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg. 2013 Sep;217(3):503-6. doi: 10.1016/j.jamcollsurg.2013.03.030. Epub 2013 Jun 28.

Reference Type BACKGROUND
PMID: 23810575 (View on PubMed)

Ris F, Findlay JM, Hompes R, Rashid A, Warwick J, Cunningham C, Jones O, Crabtree N, Lindsey I. Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function. Ann R Coll Surg Engl. 2014 Nov;96(8):579-85. doi: 10.1308/003588414X13946184900921.

Reference Type BACKGROUND
PMID: 25350178 (View on PubMed)

Barron KI, Lamvu GM, Schmidt RC, Fisk M, Blanton E, Patanwala I. Wound Infiltration With Extended-Release Versus Short-Acting Bupivacaine Before Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol. 2017 Feb;24(2):286-292. doi: 10.1016/j.jmig.2016.11.002. Epub 2016 Nov 14.

Reference Type BACKGROUND
PMID: 27856385 (View on PubMed)

Morales R Jr, Mentz H 3rd, Newall G, Patronella C, Masters O 3rd. Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty. Aesthet Surg J. 2013 Nov 1;33(8):1148-53. doi: 10.1177/1090820X13510720. Epub 2013 Nov 8.

Reference Type BACKGROUND
PMID: 24214950 (View on PubMed)

Haas E, Onel E, Miller H, Ragupathi M, White PF. A double-blind, randomized, active-controlled study for post-hemorrhoidectomy pain management with liposome bupivacaine, a novel local analgesic formulation. Am Surg. 2012 May;78(5):574-81. doi: 10.1177/000313481207800540.

Reference Type BACKGROUND
PMID: 22546131 (View on PubMed)

Knudson RA, Dunlavy PW, Franko J, Raman SR, Kraemer SR. Effectiveness of Liposomal Bupivacaine in Colorectal Surgery: A Pragmatic Nonsponsored Prospective Randomized Double Blinded Trial in a Community Hospital. Dis Colon Rectum. 2016 Sep;59(9):862-9. doi: 10.1097/DCR.0000000000000648.

Reference Type BACKGROUND
PMID: 27505115 (View on PubMed)

Hutchins JL, Kesha R, Blanco F, Dunn T, Hochhalter R. Ultrasound-guided subcostal transversus abdominis plane blocks with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after laparoscopic hand-assisted donor nephrectomy: a prospective randomised observer-blinded study. Anaesthesia. 2016 Aug;71(8):930-7. doi: 10.1111/anae.13502. Epub 2016 May 30.

Reference Type BACKGROUND
PMID: 27238859 (View on PubMed)

Stokes AL, Adhikary SD, Quintili A, Puleo FJ, Choi CS, Hollenbeak CS, Messaris E. Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery. Dis Colon Rectum. 2017 Feb;60(2):170-177. doi: 10.1097/DCR.0000000000000747.

Reference Type BACKGROUND
PMID: 28059913 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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17-2725

Identifier Type: -

Identifier Source: org_study_id

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