Development of Effective, Opioid Sparing Techniques for Peri-operative Pain Management of Transgender Patients Undergoing Gender Affirming Surgeries

NCT ID: NCT04979338

Last Updated: 2025-09-17

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

640 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-11

Study Completion Date

2026-09-30

Brief Summary

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This study will compare the current standard-of-care pain treatment regimen options that are available to patients who undergo gender-affirming surgery. The purpose of this research is to determine if any of these options are more (versus less) effective than the others to manage surgery related pain, after surgery.

Detailed Description

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Conditions

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Gender Dysphoria

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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Surgery-specific general anesthetic + ultrasound guided peripheral nerve block #1

Depending on which one of the thirteen possible gender-affirming surgeries the participant is undergoing, a combination of the following anesthetic block(s) will be used in this arm at either the pre-incision, intra-op, mid-surgery, end of surgery, or continuous time points:

* Bilateral spermatic cord block (0.5% bupivacaine, 10cc per spermatic cord)
* Local anesthetic (0.25% or 0.5% bupivacaine + 1:200K epinephrine)
* Bilateral ultrasound guided pudendal nerve block (20-40 cc of 0.25% bupivacaine + 1:200K epinephrine)
* Ultrasound guided Continuous Infraclavicular Brachial Plexus Block
* Ultrasound guided Continuous Femoral Nerve Block
* Pecs I \& II Block (0.25% bupivacaine: 15-30ml per side for Pecs I-III)

Group Type ACTIVE_COMPARATOR

Ultrasound guided Continuous Infraclavicular Brachial Plexus Block

Intervention Type OTHER

20cc of 0.25% bupivacaine + 1:200K epinephrine will be administered at start of case, 20cc of 0.25% bupivacaine + 1:200K epinephrine at end of case, and 6cc/hr of 0.25% bupivacaine at post-op \[administered by anesthesiologist\]

Ultrasound guided Continuous Femoral Nerve Block

Intervention Type OTHER

20cc of 0.25% bupivacaine + 1:200K epinephrine will be administered at start of case, 20cc of 0.25% bupivacaine + 1:200K epinephrine at end of case, and 6cc/hr of 0.25% bupivacaine at post-op \[administered by anesthesiologist\]

Ultrasound guided Pudendal Nerve Block

Intervention Type OTHER

20-40cc of 0.25% bupivacaine + 1:200K epinephrine \[administered by anesthesiologist, pre-incision\]

Bupivacaine

Intervention Type DRUG

0.25% or 0.5% with or without 1:200K epinephrine

Bilateral spermatic cord block

Intervention Type OTHER

10cc per spermatic cord of 0.5% bupivacaine \[administered by surgeon @ intraop\]

Pecs I & II Block

Intervention Type OTHER

0.25% bupivacaine: 15-30mL per side for Pecs I-III

Local anesthetic

Intervention Type OTHER

0.25% or 0.5% bupivacaine into the appropriate surgical site

Surgery-specific general anesthetic + ultrasound guided peripheral nerve block #2

Depending on which one of the thirteen possible gender-affirming surgeries the participant is undergoing, a combination of the following anesthetic block(s) will be used in this arm at either the intra-op, post-op, or end of surgery time points:

* Bilateral ultrasound-guided Transversus Abdominis Plane Block (40-60cc of 0.25% bupivacaine with 1:200K epinephrine)
* Local anesthetic (0.25 or 0.5% bupivacaine + 1:200K epinephrine)

Group Type ACTIVE_COMPARATOR

Bupivacaine

Intervention Type DRUG

0.25% or 0.5% with or without 1:200K epinephrine

Bilateral ultrasound guided Transversus Abdominis Plane Block

Intervention Type OTHER

40-60cc of 0.25% bupivacaine + 1:200K epinephrine \[administered by anesthesiologist post-op or at end of surgery\]

Local anesthetic

Intervention Type OTHER

0.25% or 0.5% bupivacaine into the appropriate surgical site

Surgery-specific general anesthetic + local anesthetic at incision site

Depending on which one of the thirteen possible gender-affirming surgeries the participant is undergoing, a combination of the following anesthetic block(s) will be used in this arm at either the mid-surgery or end of surgery time points:

* Bilateral spermatic cord block (0.5% bupivacaine, 10cc per spermatic cord)
* Local anesthetic (0.25 or 0.5% bupivacaine + 1:200K epinephrine)

Group Type ACTIVE_COMPARATOR

Bupivacaine

Intervention Type DRUG

0.25% or 0.5% with or without 1:200K epinephrine

Bilateral spermatic cord block

Intervention Type OTHER

10cc per spermatic cord of 0.5% bupivacaine \[administered by surgeon @ intraop\]

Local anesthetic

Intervention Type OTHER

0.25% or 0.5% bupivacaine into the appropriate surgical site

Interventions

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Ultrasound guided Continuous Infraclavicular Brachial Plexus Block

20cc of 0.25% bupivacaine + 1:200K epinephrine will be administered at start of case, 20cc of 0.25% bupivacaine + 1:200K epinephrine at end of case, and 6cc/hr of 0.25% bupivacaine at post-op \[administered by anesthesiologist\]

Intervention Type OTHER

Ultrasound guided Continuous Femoral Nerve Block

20cc of 0.25% bupivacaine + 1:200K epinephrine will be administered at start of case, 20cc of 0.25% bupivacaine + 1:200K epinephrine at end of case, and 6cc/hr of 0.25% bupivacaine at post-op \[administered by anesthesiologist\]

Intervention Type OTHER

Ultrasound guided Pudendal Nerve Block

20-40cc of 0.25% bupivacaine + 1:200K epinephrine \[administered by anesthesiologist, pre-incision\]

Intervention Type OTHER

Bupivacaine

0.25% or 0.5% with or without 1:200K epinephrine

Intervention Type DRUG

Bilateral ultrasound guided Transversus Abdominis Plane Block

40-60cc of 0.25% bupivacaine + 1:200K epinephrine \[administered by anesthesiologist post-op or at end of surgery\]

Intervention Type OTHER

Bilateral spermatic cord block

10cc per spermatic cord of 0.5% bupivacaine \[administered by surgeon @ intraop\]

Intervention Type OTHER

Pecs I & II Block

0.25% bupivacaine: 15-30mL per side for Pecs I-III

Intervention Type OTHER

Local anesthetic

0.25% or 0.5% bupivacaine into the appropriate surgical site

Intervention Type OTHER

Other Intervention Names

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Marcaine

Eligibility Criteria

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Inclusion Criteria

* Transgender persons 18 years and older
* Undergoing gender affirming surgeries performed by either Dr. Maurice Garcia (orchiectomy only, vaginoplasty with or without canal \& orchiectomy, colon-vaginoplasty, \& peritoneal vaginoplasty; Stage I phalloplasty, or stage II phalloplasty); Dr. Edward Ray (feminizing chest surgery, masculinizing chest surgery, stage I phalloplasty); Dr. Amit Gupta (orchiectomy and peritoneal vaginoplasty only); or Dr. Yosef Nasseri (colon vaginoplasty surgery)

* Any contraindications to the study drugs.
* Patients with neurologic deficits that preclude them from sensing pain.
* Patients with implanted pain neuromodulator devices (e.g., neurostimulator)
* Patients who do not speak English
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cedars-Sinai Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Maurice M. Garcia

Director of the Cedars-Sinai Transgender Surgery and Health Program

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maurice M Garcia, M.D., MAS

Role: PRINCIPAL_INVESTIGATOR

Cedars-Sinai Medical Center

Locations

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Cedars-Sinai Medical Center - North and South Towers

Los Angeles, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jenna Stelmar, BS

Role: CONTACT

805-813-7882

Facility Contacts

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Maurice M Garcia, M.D., MAS

Role: primary

310-423-4256

Other Identifiers

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STUDY00000879

Identifier Type: -

Identifier Source: org_study_id

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