Thoracic Epidural Analgesia Versus Rectus Sheath Block Versus Surgeon Infiltration With Liposomal Bupivacaine or Standard Bupivacaine for Post-Operative Pain Control After Cystectomy

NCT ID: NCT04300231

Last Updated: 2025-02-10

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-22

Study Completion Date

2021-12-24

Brief Summary

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The purpose of this study is to compare the difference between four different pain control methods in patients who will be having a cystectomy surgery (surgical removal of the bladder).

Detailed Description

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The purpose of this study is to compare the difference between four different pain control methods in patients who will be having a cystectomy surgery (surgical removal of the bladder). By collecting this data, we aim to show improved postoperative pain scores, decreased opioid needs, and decreased opioid side effects (feeling sick to your stomach, feeling drowsy/sleepy, blockage/lack of movement in the intestines, inability to completely empty the bladder, unusually slow or shallow breathing).

The specific aim of this study is to compare the difference between the pain control methods in achieving the following:

1. Decreased opioid requirements
2. Improved postoperative VAS pain scores
3. Decreased opioid side effects (Nausea, sedation, ileus, respiratory depression)
4. Decreased hospital length of stay (LOS)

Conditions

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Cystectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1. Thoracic Epidural Analgesia
2. Rectus Sheath Block
3. Surgeon Infiltration with Liposomal Bupivacaine
4. Standard Bupivacaine
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Thoracic epidural

1\. Thoracic epidural- epidural bupivacaine 0.05%/hydromorphone 0.05mg/ml mix will be given throughout the duration of their epidural analgesia.

Group Type ACTIVE_COMPARATOR

epidural bupivacaine 0.05%

Intervention Type DRUG

Mix of epidural bupivacaine 0.05% and hydromorphone 0.05mg/ml will be given using PCEA.

/hydromorphone 0.05mg/ml

Intervention Type DRUG

Mix of epidural bupivacaine 0.05% and hydromorphone 0.05mg/ml will be given using PCEA.

Rectus Sheath Block

2\. Rectus Sheath Block - 20 mL of Exparel® diluted with 40 mL of 0.125% bupivacaine and 40 ml of injectable saline for a total of 100 mL. The 100 mL will be injected into 4 locations below the rectus abdominis muscle.

Group Type ACTIVE_COMPARATOR

Liposomal bupivacaine

Intervention Type DRUG

20 ml

bupivacaine 0.125%

Intervention Type DRUG

40 mL

injectable saline

Intervention Type DRUG

40 mL

Surgeon Infiltration with Liposomal Bupivacaine (LB)

3\. Surgeon infiltration with Liposomal Bupivacaine (LB) - 20 mL of Exparel® diluted with 40 mL of 0.125% bupivacaine and 40 ml of injectable saline for a total of 100 mL. The 100 mL will be injected throughout the incision site by the surgeon at the end of surgery, prior to abdominal wall closure.

Group Type ACTIVE_COMPARATOR

Liposomal bupivacaine

Intervention Type DRUG

20 ml

bupivacaine 0.125%

Intervention Type DRUG

40 mL

injectable saline

Intervention Type DRUG

40 mL

Surgeon Infiltration

4\. Surgeon infiltration with Standard Bupivacaine (SB) - 60ml of 0.25% bupivacaine will be diluted with 40ml of saline for a total of 100ml. The 100 mL will be injected throughout the incision site by the surgeon at the end of surgery.

Group Type ACTIVE_COMPARATOR

bupivacaine 0.5%

Intervention Type DRUG

60 mL

injectable saline

Intervention Type DRUG

40 mL

Interventions

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epidural bupivacaine 0.05%

Mix of epidural bupivacaine 0.05% and hydromorphone 0.05mg/ml will be given using PCEA.

Intervention Type DRUG

Liposomal bupivacaine

20 ml

Intervention Type DRUG

bupivacaine 0.125%

40 mL

Intervention Type DRUG

bupivacaine 0.5%

60 mL

Intervention Type DRUG

/hydromorphone 0.05mg/ml

Mix of epidural bupivacaine 0.05% and hydromorphone 0.05mg/ml will be given using PCEA.

Intervention Type DRUG

injectable saline

40 mL

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing cystectomy for bladder cancer
* ASA class 1, 2, 3 or 4
* Age 18 or older, male or female
* Desires Regional anesthesia for postoperative pain control

Exclusion Criteria

* Any contraindication for thoracic epidural.
* History of substance abuse in the past 6 months.
* Patients on more than 30mg morphine equivalents of opioids daily.
* Any physical, mental or medical conditions which in the opinion of the investigators, may confound quantifying postoperative pain resulting from surgery.
* Known allergy or other contraindications to the study medications (Acetaminophen, Gabapentin, Bupivacaine, Hydromorphone).
* Postoperative intubation.
* Any patient with history of neuropathic bowel or bladder dysfunction
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Indiana University

OTHER

Sponsor Role lead

Responsible Party

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Yar Yeap

Director, Acute Pain Service, Assistant Professor of Clinical Anesthesiology, Dept of Anesthesiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yar Yeap, MD

Role: PRINCIPAL_INVESTIGATOR

Indiana University Hospital

Locations

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Indiana Univeristy

Indianapolis, Indiana, United States

Site Status

Countries

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United States

References

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Butterworth Iv, John F., David C. Mackey, and John D. Wasnick.

Reference Type BACKGROUND

de Boer, H. D., O. Detriche, and P. Forget.

Reference Type BACKGROUND

Guo, Q., R. Li, L. Wang, D. Zhang, and Y. Ma.

Reference Type BACKGROUND

Hou, X., Z. Luo, H. Wang, Y. Zhan, L. Yang, and L. Li.

Reference Type BACKGROUND

Kalogera, E., J. N. Bakkum-Gamez, A. L. Weaver, J. P. Moriarty, B. J. Borah, C. L. Langstraat, C. J. Jankowski, et al.

Reference Type BACKGROUND

Ladjevic N, Likic-Ladjevic I, Dzamic Z, Acimovic M, Dragicevic D, Durutovic O. Combined general and epidural anaesthesia versus general anaesthesia for radical cystectomy. Acta Chir Iugosl. 2007;54(4):89-91. doi: 10.2298/aci0704089l.

Reference Type BACKGROUND
PMID: 18595236 (View on PubMed)

Mazul-Sunko B, Gilja I, Jelisavac M, Kozul I, Troha D, Osmancevic N, El-Saleh A, Markic A, Kovacevic M, Bokarica P. Thoracic epidural analgesia for radical cystectomy improves bowel function even in traditional perioperative care: a retrospective study in eighty-five patients. Acta Clin Croat. 2014 Sep;53(3):319-25.

Reference Type BACKGROUND
PMID: 25509242 (View on PubMed)

Ozyuvaci E, Altan A, Karadeniz T, Topsakal M, Besisik A, Yucel M. General anesthesia versus epidural and general anesthesia in radical cystectomy. Urol Int. 2005;74(1):62-7. doi: 10.1159/000082712.

Reference Type BACKGROUND
PMID: 15711112 (View on PubMed)

ozek, J. J., M. De Ruyter, and T. W. Khan.

Reference Type BACKGROUND

Sun, J. X., K. Y. Bai, Y. F. Liu, G. Du, Z. H. Fu, H. Zhang, J. H. Yang, et al.

Reference Type BACKGROUND

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1905006917

Identifier Type: -

Identifier Source: org_study_id

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