Efficacy of Opioid-limiting Pain Management Protocol in Men Undergoing Urethroplasty

NCT ID: NCT03859024

Last Updated: 2024-09-19

Study Results

Results available

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

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-22

Study Completion Date

2023-06-30

Brief Summary

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The investigator's study aims to see if an enhanced recovery regimen of pain medications before and during surgery will decrease the use and risk of opioid pain medications as well as improve pain control in anterior urethroplasty patients. Participants will be randomized to one of two pain regimens (enhanced recovery regimen vs standard regimen).

Detailed Description

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The purpose of this study is to assess the difference in narcotics usage between two different pain management protocols after urethroplasty. Management at the current time varies between giving intraoperative painkillers along with peripheral nerve blocks in some patients, while others do not receive this protocol. In this study, one group will continue the historical standard of care of the hospital, receiving postoperative nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotics for pain control. The other group will utilize a protocol to lower narcotics usage, including acetaminophen, gabapentin, Celebrex, and local anesthetic (bupivacaine) in an attempt to reduce the usage of narcotics postoperatively. Given the heightened concern over narcotic usage by postoperative patients, including the risk of chronic usage by even young patients, the objective will be to assess if using this protocol as a new standard can limit the need for postoperative narcotics prescriptions.

In related urological procedures, bupivacaine injections given before surgeries have been shown to significantly lower pain scores after surgery for patients undergoing penile prosthesis. The University of Alabama at Birmingham has also been using an Enhanced Recovery After Surgery (ERAS) protocol, a multimodal presurgical care pathway designed to achieve early recovery after surgical procedures, for cystectomy and seen reduced narcotic usage among those patients.

This study would potentially help determine a new pain management protocol for urology patients undergoing anterior urethroplasty that is both more effective and less risky.

Conditions

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Pain, Postoperative Urethral Stricture

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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Standard Protocol

Patients will receive the historical standard for pain management, which may include narcotics during and after surgery. Postoperative prescriptions ibuprofen 800 mg, and acetaminophen 1000 mg to be taken on a scheduled basis then as needed. Another prescription for oxycodone will be given to be used only if needed.

Group Type ACTIVE_COMPARATOR

Oxycodone

Intervention Type DRUG

oxycodone tablet

Acetaminophen

Intervention Type DRUG

acetaminophen tablet

Ibuprofen 800 mg

Intervention Type DRUG

ibuprofen tablet

Enhanced Recovery Protocol

A combination regimen of acetaminophen, Celebrex and gabapentin pre-op, with 30 mL of 0.5% bupivacaine and 4 mg of dexamethasone given as a perineal nerve block at the time of urethroplasty surgery. Narcotics will be administered judiciously and ass seen fit by the anesthesia and/or surgical teams. Postoperative prescriptions ibuprofen 800 mg, and acetaminophen 1000 mg to be taken on a scheduled basis then as needed. Another prescription for oxycodone will be given to be used only if needed.

Group Type EXPERIMENTAL

Oxycodone

Intervention Type DRUG

oxycodone tablet

Acetaminophen

Intervention Type DRUG

acetaminophen tablet

Gabapentin

Intervention Type DRUG

gabapentin tablet

celebrex

Intervention Type DRUG

Celebrex tablet

Bupivacaine

Intervention Type DRUG

bupivacaine injection

Ibuprofen 800 mg

Intervention Type DRUG

ibuprofen tablet

Dexamethasone

Intervention Type DRUG

Dexamethasone injection

Interventions

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Oxycodone

oxycodone tablet

Intervention Type DRUG

Acetaminophen

acetaminophen tablet

Intervention Type DRUG

Gabapentin

gabapentin tablet

Intervention Type DRUG

celebrex

Celebrex tablet

Intervention Type DRUG

Bupivacaine

bupivacaine injection

Intervention Type DRUG

Ibuprofen 800 mg

ibuprofen tablet

Intervention Type DRUG

Dexamethasone

Dexamethasone injection

Intervention Type DRUG

Other Intervention Names

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oxycontin tylenol neurontin celecoxib marcaine, exparel advil, motrin decadron, ozurdex

Eligibility Criteria

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Inclusion Criteria

* Men greater than 18 years of age who are scheduled for anterior urethroplasty surgery

Exclusion Criteria

* Any patient not classified as a II or III on the American Society of Anesthesiologists (ASA) physical status classification system.
* General anesthesia or neuraxial anesthesia with epidural used as anesthetic techniques
* Allergy/intolerance to local anesthetic or steroids
* Pre-existing neurological and/or anatomical deficit that would preclude regional block
* Coexisting coagulopathy such as hemophilia or von Willebrand Disease
* BMI greater than 40 or less then 20
* History of intravenous drug or opioid abuse
* History of opioid use within a week prior to urethroplasty
* History of any chronic pain syndrome
* Posterior urethroplasty
* Patients with chronic kidney disease
* Patients allergic to NSAIDs
* Patients requiring more than one buccal graft harvest
* Patients with graft urethroplasty with site other than buccal
* Patients with a history of previous urethroplasty
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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University of Alabama at Birmingham

OTHER

Sponsor Role lead

Responsible Party

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Adam Baumgarten

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John P Selph, MD

Role: PRINCIPAL_INVESTIGATOR

University of Alabama at Birmingham

Locations

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University of Alabama of Birmingham

Birmingham, Alabama, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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IRB-300002992

Identifier Type: -

Identifier Source: org_study_id

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