Efficacy and Safety of EXPAREL Versus Standard of Care (SoC) in Subjects Undergoing Elective Cesarean Section

NCT ID: NCT03853694

Last Updated: 2022-07-18

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

167 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-04

Study Completion Date

2020-01-16

Brief Summary

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The purpose of this study is to compare total opioid consumption by subjects in different treatment groups.

Another purpose of this study is to assess how well EXPAREL works, collect any safety data and assess your satisfaction using EXPAREL.

Detailed Description

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This is a Phase-4, multicenter, randomized, active-controlled study in approximately 182 adult women undergoing elective C-section. All subjects will remain in the hospital for up to 72 hours post surgery.

Subjects will be screened within 30 days prior to surgery. During the screening visit, subjects will be assessed for any past or present medical conditions that in the opinion of the investigator would preclude them from study participation.

After the Informed Consent Form (ICF) is signed, a medical history, surgical history, physical examination, 12-lead electrocardiogram (ECG), vital sign measurements, alcohol breath test and urine drug screen, and clinical laboratory tests (hematology and chemistry) will be performed.

On Day 1, prior to the C-section, eligible subjects will be randomized in a 1:1:1 ratio into one of the three treatment groups listed below:

* Group 1: 150 mcg Duramorph® (SOC arm)+ postoperative multi-modal pain regimen as defined in this protocol. No EXPAREL TAP infiltration following skin-incision closure.
* Group 2: 50 mcg Duramorph + EXPAREL TAP infiltration following skin-incision closure + postoperative multi-modal pain regimen as defined in this protocol.
* Group 3: EXPAREL TAP infiltration following skin-incision closure + postoperative multi-modal pain regimen as defined in this protocol. No Duramorph.

Rescue Medication will be provided, as needed, for all subjects.

Subjects will remain in the hospital for up to 72 hours after surgery.

Total opioid burden and Pain intensity scores using a 10 cm Visual Analog Scale (VAS) will be collected.

Daily pain intensity score (VAS) and all pain medications will be collected through Day 14.

A phone call will be made to each subject on Day 14 and Day 30.

Conditions

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Elective Cesarean Section Pain Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1 (Standard of Care Group)

150 mcg Duramorph® + postoperative multi-modal pain regimen. No EXPAREL TAP infiltration

Group Type ACTIVE_COMPARATOR

150 mcg Duramorph + multi-modal pain regimen

Intervention Type DRUG

Intrathecal injection of 150 mcg Duramorph + multi-modal pain regimen.

Group 2 (Duramorph + EXPAREL TAP)

50 mcg Duramorph + EXPAREL TAP infiltration + postoperative multi-modal pain regimen.

Group Type EXPERIMENTAL

50 mcg Duramorph+ EXPAREL + multi-modal pain regimen

Intervention Type DRUG

Intrathecal injection of 50 mcg Duramorph + EXPAREL administered via TAP infiltration + multi-modal pain regimen.

Group 3 (EXPAREL TAP)

EXPAREL TAP infiltration + postoperative multi-modal pain regimen. No Duramorph.

Group Type EXPERIMENTAL

Exparel TAP + multi-modal pain regimen

Intervention Type DRUG

EXPAREL administered via TAP infiltration + multi-modal pain regimen.

Interventions

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50 mcg Duramorph+ EXPAREL + multi-modal pain regimen

Intrathecal injection of 50 mcg Duramorph + EXPAREL administered via TAP infiltration + multi-modal pain regimen.

Intervention Type DRUG

150 mcg Duramorph + multi-modal pain regimen

Intrathecal injection of 150 mcg Duramorph + multi-modal pain regimen.

Intervention Type DRUG

Exparel TAP + multi-modal pain regimen

EXPAREL administered via TAP infiltration + multi-modal pain regimen.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Females 18 years of age and older at screening.
2. Term pregnancies of 37 to 42 weeks gestation, scheduled to undergo elective C-section.
3. American Society of Anesthesiology (ASA) physical status 1, 2, or 3.
4. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments.

Exclusion Criteria

1. Subjects who, in the opinion of the study site principal investigator, have a high-risk pregnancy.
2. Subjects with a pregnancy-induced medical condition or complication.
3. Subjects with 3 or more prior C-sections.
4. Pre-pregnancy body mass index \>50 kg/m2.
5. Allergy, hypersensitivity, intolerance, or contraindication to any of the study medications.
6. Planned concurrent surgical procedure with the exception of salpingo-oophorectomy or tubal ligation.
7. Severely impaired renal or hepatic function.
8. Subjects at an increased risk for bleeding or a coagulation disorder.
9. Concurrent painful physical condition that may require analgesic treatment in the postsurgical period for pain that is not strictly related to the surgery.
10. Clinically significant medical disease in either the mother or baby that, in the opinion of the investigator, would make participation in a clinical study inappropriate.
11. History of, suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years.
12. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug.
13. Previous participation in an EXPAREL study.
14. Any clinically significant event or condition uncovered during the surgery that might render the subject medically unstable or complicate the subject's postsurgical course.
15. Receives the epidural component of combined spinal epidural (CSE) anesthesia during the study.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Pacira Pharmaceuticals, Inc

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nayana Nagaraj, MD, PhD, MPH

Role: STUDY_DIRECTOR

Pacira Pharmaceuticals, Inc

Locations

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Stanford University School of Medicine

Stanford, California, United States

Site Status

University of Florida- Gainesville

Gainesville, Florida, United States

Site Status

University of Florida college of Medicine - Jacksonville

Jacksonville, Florida, United States

Site Status

Clinical Research Prime

Idaho Falls, Idaho, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Henry Ford Hospital

Detroit, Michigan, United States

Site Status

Robert Wood Johnson Medical School

New Brunswick, New Jersey, United States

Site Status

St. Peter's University Medical Center

New Brunswick, New Jersey, United States

Site Status

Columbia University Medical Center/NY Presbyterian Hospital

New York, New York, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Ohio State University

Columbus, Ohio, United States

Site Status

Thomas Jefferson Medical Center

Philadelphia, Pennsylvania, United States

Site Status

Magee-Women's Hospital of UPMC

Pittsburgh, Pennsylvania, United States

Site Status

The University of Texas Medical Branch

Galveston, Texas, United States

Site Status

Inova Health System

Falls Church, Virginia, United States

Site Status

West Virginia University

Morgantown, West Virginia, United States

Site Status

Countries

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United States

References

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Habib AS, Nedeljkovic SS, Horn JL, Smiley RM, Kett AG, Vallejo MC, Song J, Scranton R, Bao X. Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. J Clin Anesth. 2021 Dec;75:110527. doi: 10.1016/j.jclinane.2021.110527. Epub 2021 Oct 6.

Reference Type DERIVED
PMID: 34626927 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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402-C-414

Identifier Type: -

Identifier Source: org_study_id

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