The Analgesic Efficacy of Continuous Sub-fascial Bupivacaine Infusion and Lidocaine Patches in Post-cesarean Patients With Opiate Use Disorder: A Comparative Efficacy Analysis

NCT ID: NCT04033562

Last Updated: 2021-06-07

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

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-15

Study Completion Date

2021-05-17

Brief Summary

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Pregnant women with a history of opioid use disorder, chronic opioid use or those who are on medication assisted treatment will be randomly assigned to receive either a sub-fascial continuous infusion of bupivacaine or lidocaine/menthol patch after Cesarean delivery. Post-operative pain scores and opioid usage in the post-operative period will be recorded.

Detailed Description

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Pregnant women 18 years or older with a history of chronic opioid use, opioid use disorder or women on medication assisted treatment (MAT), will be enrolled in the study and randomly assigned to one of two study groups. The first group will receive a Lidocaine/Menthol patch at the time of her Cesarean delivery, the second will receive placement of the Ambu ACTion infusion pain system at the time of the C-section. This device will be set up to infuse 0.125% of bupivacaine for 48-60hrs postoperatively at a rate of 8cc/hr.

Conditions

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Opioid-use Disorder Opioid Use Opioid Dependence Opioid Abuse Medication Assisted Treatment Infusion Catheter, Wound Lidopatch Ambu ACTion Pregnancy Related Cesarean Section

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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Lidoderm patch

Participants will receive a topical 3.6% Lidocaine/1.25% Menthol patch at the time of their Cesarean section. Patches will be replaced every 12 hours for a total of 60 hours.

Group Type ACTIVE_COMPARATOR

Lidocaine patch

Intervention Type DRUG

Lidocaine patch will be applied at time of Cesarean delivery for post-operative pain control.

Infusion pump

Participants will undergo placement of Ambu ACTion drug delivery system at the time of Cesarean delivery. 0.125% of bupivacaine will be infused at a rate of 8cc/hr for a total of 48-60hrs post-operatively.

Group Type ACTIVE_COMPARATOR

Ambu ACTion pump, 0.125% bupivacaine at 8cc/hr

Intervention Type DEVICE

Infusion pump will be placed at time of Cesarean delivery for post-operative pain control.

Interventions

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Lidocaine patch

Lidocaine patch will be applied at time of Cesarean delivery for post-operative pain control.

Intervention Type DRUG

Ambu ACTion pump, 0.125% bupivacaine at 8cc/hr

Infusion pump will be placed at time of Cesarean delivery for post-operative pain control.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Pregnancy
* undergoing a Cesarean delivery via a transverse incision at York Hospital labor and delivery
* Documented history of chronic opioid use or documented OUD, or currently utilizing medically assisted treatment (MAT)

Exclusion Criteria

* Patients with a history of clinically significant cardiovascular, hepatic, or renal disease
* Non-English speaking
* Allergy to bupivacaine, lidocaine, zinc, silver or menthol
* Unable to consent, due to lack of decisional capacity or need for emergent Cesarean delivery
* History of glucose-6-phosphate deficiency
* Use of anti-arrhythmic drugs such as tocainide or mexiletine
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Ambu A/S

INDUSTRY

Sponsor Role collaborator

York Opioid Collaborative, Pennsylvania

UNKNOWN

Sponsor Role collaborator

WellSpan Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paul Burcher, MD

Role: PRINCIPAL_INVESTIGATOR

WellSpan Health Ob-Gyn Residency Program Director

Locations

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WellSpan Health York Hospital

York, Pennsylvania, United States

Site Status

Countries

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United States

References

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Ranta PO, Ala-Kokko TI, Kukkonen JE, Ohtonen PP, Raudaskoski TH, Reponen PK, Rawal N. Incisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study. Int J Obstet Anesth. 2006 Jul;15(3):189-94. doi: 10.1016/j.ijoa.2006.02.003.

Reference Type BACKGROUND
PMID: 16798442 (View on PubMed)

Fredman B, Shapiro A, Zohar E, Feldman E, Shorer S, Rawal N, Jedeikin R. The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg. 2000 Dec;91(6):1436-40. doi: 10.1097/00000539-200012000-00025.

Reference Type BACKGROUND
PMID: 11093995 (View on PubMed)

Givens VA, Lipscomb GH, Meyer NL. A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol. 2002 Jun;186(6):1188-91. doi: 10.1067/mob.2002.122984.

Reference Type BACKGROUND
PMID: 12066096 (View on PubMed)

Kainu JP, Sarvela J, Halonen P, Puro H, Toivonen HJ, Halmesmaki E, Korttila KT. Continuous wound infusion with ropivacaine fails to provide adequate analgesia after caesarean section. Int J Obstet Anesth. 2012 Apr;21(2):119-24. doi: 10.1016/j.ijoa.2011.12.009. Epub 2012 Feb 16.

Reference Type BACKGROUND
PMID: 22341892 (View on PubMed)

Lalmand M, Wilwerth M, Fils JF, Van der Linden P. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study. Anesth Analg. 2017 Sep;125(3):907-912. doi: 10.1213/ANE.0000000000001892.

Reference Type BACKGROUND
PMID: 28368941 (View on PubMed)

Jolly C, Jathieres F, Keita H, Jaouen E, Guyot B, Torre A. Cesarean analgesia using levobupivacaine continuous wound infiltration: a randomized trial. Eur J Obstet Gynecol Reprod Biol. 2015 Nov;194:125-30. doi: 10.1016/j.ejogrb.2015.08.023. Epub 2015 Aug 25.

Reference Type BACKGROUND
PMID: 26366789 (View on PubMed)

Guidelines for laparoscopic surgery during pregnancy. Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Surg Endosc. 1998 Feb;12(2):189-90. No abstract available.

Reference Type BACKGROUND
PMID: 9479743 (View on PubMed)

Habib AS, Polascik TJ, Weizer AZ, White WD, Moul JW, ElGasim MA, Gan TJ. Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy. Anesth Analg. 2009 Jun;108(6):1950-3. doi: 10.1213/ane.0b013e3181a21185.

Reference Type BACKGROUND
PMID: 19448228 (View on PubMed)

Kwon YS, Kim JB, Jung HJ, Koo YJ, Lee IH, Im KT, Woo JS, Im KS. Treatment for postoperative wound pain in gynecologic laparoscopic surgery: topical lidocaine patches. J Laparoendosc Adv Surg Tech A. 2012 Sep;22(7):668-73. doi: 10.1089/lap.2011.0440. Epub 2012 Aug 3.

Reference Type BACKGROUND
PMID: 22861076 (View on PubMed)

Khanna M, Peters C, Singh JR. Treating pain with the lidocaine patch 5% after total knee arthroplasty. PM R. 2012 Sep;4(9):642-6. doi: 10.1016/j.pmrj.2012.06.003. Epub 2012 Jul 28.

Reference Type BACKGROUND
PMID: 22841969 (View on PubMed)

Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):530-9. doi: 10.4103/0970-9185.119172.

Reference Type BACKGROUND
PMID: 24249993 (View on PubMed)

Brower MC, Johnson ME. Adverse effects of local anesthetic infiltration on wound healing. Reg Anesth Pain Med. 2003 May-Jun;28(3):233-40. doi: 10.1053/rapm.2003.50050. No abstract available.

Reference Type BACKGROUND
PMID: 12772142 (View on PubMed)

Tam KW, Chen SY, Huang TW, Lin CC, Su CM, Li CL, Ho YS, Wang WY, Wu CH. Effect of wound infiltration with ropivacaine or bupivacaine analgesia in breast cancer surgery: A meta-analysis of randomized controlled trials. Int J Surg. 2015 Oct;22:79-85. doi: 10.1016/j.ijsu.2015.07.715. Epub 2015 Aug 12.

Reference Type BACKGROUND
PMID: 26277531 (View on PubMed)

Scott NB. Wound infiltration for surgery. Anaesthesia. 2010 Apr;65 Suppl 1:67-75. doi: 10.1111/j.1365-2044.2010.06241.x.

Reference Type BACKGROUND
PMID: 20377548 (View on PubMed)

Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Transl Perioper Pain Med. 2015;1(2):1-7.

Reference Type BACKGROUND
PMID: 26413558 (View on PubMed)

Related Links

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http://wonder.cdc.gov

Wide-ranging online data for epidemiologic research (WONDER)

Other Identifiers

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1351850

Identifier Type: -

Identifier Source: org_study_id

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