Subpectoral Bupivacaine for Pain Management in Adolescent Reduction Mammaplasty

NCT ID: NCT05898087

Last Updated: 2025-05-29

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE4
• Total Enrollment: 128 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-04-01
• Study Completion Date: 2026-04-01

Brief Summary

The main question this randomized control trial aims to answer is:

• Is the use of intraoperative subpectoral bupivacaine associated with decreased post-operative pain in adolescent patients who undergo bilateral reduction mammaplasty

Participants will be randomized into the study group that intraoperatively receives 30cc of subpectoral bupivacaine injections or into the control group that intraoperatively receives 30cc of injectable saline subpectorally. All participants will keep a pain log and pain medication log at home for the first week following surgery.

Researchers will compare to see if patients who receive subpectoral bupivacaine have lower pain scores in the PACU, and lower use of narcotics post-operatively when compared to the control group who receive injectable saline.

Detailed Description

1. All team members will be extensively trained on the proceedings of this trial

2. Patients will be recruited at their initial consultation, or subsequent pre-operative visit.

3. All patients that are approached will be recorded into an excel sheet. If they decline the study- this will be listed along with any provided reasoning for declining.

4. Once consent is obtained, the patient will be randomized into either the study group (receiving intraoperative subpectoral bupivacaine) or the control group (will not receive subpectoral bupivacaine.) Block randomization will be performed using randomizer.org. For every forty patients, twenty will be randomized into the control group, and twenty into the bupivacaine group. Patients will be blinded to the which group they are placed in. The PI and study staff are not blinded.

5. Per standard protocol, patients will undergo urine pregnancy testing in the pre-operative area. If results are positive, patients will be informed of the results in a private area. Surgery will be postponed and patients will be then excluded from the study.

6. Patients will undergo their procedure with their assigned intervention. Intra-operative anesthetic and pain control regimens will otherwise be standardized with the anesthesia team to remove other confounding factors/variables.

7. Administration of the saline/bupivacaine will be just below the fascia of the pectroalis major. This will occur following resection of the specimen and achievement of hemostasis, prior to closure of the wounds. Injections will be in a fan-like pattern, beginning at the inferolateral border of the pectoral is muscle, extending superomedially with injection, spanning the anterior surface of the pectroalis major. This will be performed under direct visualization; no imaging assistance is necessary. Each patient will receive 5 injections, 3mL per injection bilaterally. A total of 30mL of saline or bupivacaine will be injected.

8. PACU nurses will record pain scores upon arrival into the PACU, as well as upon discharge home from the hospital. All patients will receive the same amount of prescribed narcotic. They will be sent home with a log. Patients will record a daily pain score, and the number of doses of ibuprofen, acetaminophen and oxycodone.

9. As an internal quality control measure, research staff will call patients within 72 hours from surgery to ensure they are completing the pain score and medication log daily.

10. The clinician (MD, PA, or nurse) will go through the survey questions with patients at their 1 and 4 week post-operative visits. These questions are typical questions asked at follow-up and will not add significant time to the clinic visit. All clinical staff asking these surveys is familiar with the information. (see appendices)

11. Data will be collected at the 1 and 4 week post-operative visit in the plastic surgery clinic Further data (PACU length of stay, PACU pain scores) will be determined by performing chart review.

12. To minimize error and maximize quality, only a few clinicians (3-4 max) will be those obtaining the survey results in clinic. All questions will be asked by reading verbatim from the survey to avoid bias when questioning. Scores will be entered into an excel file each day at the end of clinic.

13. The spreadsheet will be password protected to ensure patient privacy. Only the surgeon, PA and RN will have access to this.

14. Interim analyses will be performed after 60 patients have undergone treatment in order to assess if the study is meeting the intended objectives.

Conditions

Macromastia; Post-operative Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Study Group 1 - Intervention

Participants in this group will receive 20cc of subpectoral bupivacaine injected into the fascia

Group Type: EXPERIMENTAL

Marcaine 0.25 % Injectable Solution

Intervention Type: DRUG

Patients in this arm will receive an injection of 20cc of injectable 0.25% bupivacaine solution. It will be injected in a fan-like pattern beneath the pectoralis fascia

Study Group 2 - Control

Participants in this group will receive 20cc of subpectoral saline injected into the fascia

Group Type: PLACEBO_COMPARATOR

Saline

Intervention Type: DRUG

Patients in this arm will receive an injection of 20cc of injectable saline. It will be injected in a fan-like pattern beneath the pectoralis fascia

Interventions

Marcaine 0.25 % Injectable Solution

Patients in this arm will receive an injection of 20cc of injectable 0.25% bupivacaine solution. It will be injected in a fan-like pattern beneath the pectoralis fascia

Intervention Type: DRUG

Saline

Patients in this arm will receive an injection of 20cc of injectable saline. It will be injected in a fan-like pattern beneath the pectoralis fascia

Intervention Type: DRUG

Other Intervention Names

bupivacaine 0.25% injectable solution; injectable saline

Eligibility Criteria

Inclusion Criteria

1. Female

2. Age 13-25 at the time of surgery

3. Undergoing bilateral reduction mammaplasty at Connecticut Children's from 1/1/2022-12/31/2025.

4. Ability of child's parent/legal guardian to understand and the willingness to sign a written informed consent document.

9. Patients lost to follow-up- they must be seen within 1 week and 4 weeks post-operatively

Exclusion Criteria

1. Patients with history of substance use disorder or "chronic pain" defined as pain requiring management and treatment by a pain management specialist.

2. Patients already taking narcotics at the time of surgery.

3. Patients with a history of hepatic or renal dysfunction.

4. Patients with known allergy to bupivacaine.

5. Patients who are pregnant, determined by urine testing in pre-operative area.

6. Patients who are non-verbal or have developmental delays that would result in inability to report reliable pain scores.

7. Patients with significant post-operative complications

• Minimum Eligible Age: 13 Years
• Maximum Eligible Age: 25 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Connecticut Children's Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Christopher Hughes, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Connecticut Children's

Locations

Connecticut Children's

Farmington, Connecticut, United States

Site Status: RECRUITING

Connecticut Children's

Hartford, Connecticut, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Lauren C Schmidtberg, PA-C

Role: CONTACT

lschmidtberg@connecticutchildrens.org

860-545-9360

Christopher Hughes, MD, MPH

Role: CONTACT

chughes02@connecticutchildrens.org

860-545-9360

Facility Contacts

Lauren C Schmidtberg

Role: primary

lschmidtberg@connecticutchildrens.org

860-545-9360

Lauren C Schmidtberg

Role: primary

lschmidtberg@connecticutchildrens.org

860-545-9360

References

Wallace CC, Wetzel ME, Howell C, Vasconez HC. The Efficacy of Pectoralis Nerve Blockade in Breast Reductions: A Prospective Randomized Trial. Ann Plast Surg. 2021 Jun 1;86(6S Suppl 5):S632-S634. doi: 10.1097/SAP.0000000000002763.

Reference Type: RESULT

PMID: 33625027 (View on PubMed)

Lu L, Fine NA. The efficacy of continuous local anesthetic infiltration in breast surgery: reduction mammaplasty and reconstruction. Plast Reconstr Surg. 2005 Jun;115(7):1927-34; discussion 1935-6. doi: 10.1097/01.prs.0000163332.04220.bd.

Reference Type: RESULT

PMID: 15923838 (View on PubMed)

Kryger ZB, Rawlani V, Lu L, Fine NA. Decreased postoperative pain, narcotic, and antiemetic use after breast reduction using a local anesthetic pain pump. Ann Plast Surg. 2008 Aug;61(2):147-52. doi: 10.1097/SAP.0b013e31815a23ef.

Reference Type: RESULT

PMID: 18650606 (View on PubMed)

Other Identifiers

21-167-CCMC

Identifier Type: -

Identifier Source: org_study_id