Pudendal Block Using Liposomal Bupivacaine vs. Standard Treatment During Sacrospinous Ligament Fixation
| Status: | Recruiting |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/4/2018 |
| Start Date: | September 24, 2018 |
| End Date: | May 1, 2020 |
| Contact: | Ricardo Caraballo, MD |
| Email: | ricardo.caraballo@atlantichealth.org |
| Phone: | 973-971-7267 |
Pudendal Block Using Liposomal Bupivacaine vs. Standard Treatment During Sacrospinous Ligament Fixation: a Prospective Randomized Clinical Trial
A pudendal nerve block is a procedure where a local anesthetic is injected where the pudendal
nerve is located. This allows quick pain relief to the perineum, vulva, and vagina. The
purpose of this research study is see if injecting a long-acting local anesthetic, called
Liposomal Bupivacaine (EXPAREL), will result in less post-operative pain after having vaginal
prolapse surgery.
Typical post-operative pain lasts a few days. Short-acting anesthetics only provide pain
relief in the few hours after surgery. EXPAREL will add the benefit of longer acting pain
relief that can last up to 72 hours with the same safety profile. EXPAREL is an FDA-approved
medication. It has been used and studied extensively in gynecologic surgery for incisional
pain. It has also been studied in Urology and Orthopedic surgery with an excellent safety
profile with good pain relief.
nerve is located. This allows quick pain relief to the perineum, vulva, and vagina. The
purpose of this research study is see if injecting a long-acting local anesthetic, called
Liposomal Bupivacaine (EXPAREL), will result in less post-operative pain after having vaginal
prolapse surgery.
Typical post-operative pain lasts a few days. Short-acting anesthetics only provide pain
relief in the few hours after surgery. EXPAREL will add the benefit of longer acting pain
relief that can last up to 72 hours with the same safety profile. EXPAREL is an FDA-approved
medication. It has been used and studied extensively in gynecologic surgery for incisional
pain. It has also been studied in Urology and Orthopedic surgery with an excellent safety
profile with good pain relief.
Various clinical studies have indicated that preemptive analgesia can effectively reduce pain
as well as analgesic requirements in the post-operative period. Pudendal nerve blockade has
been used successfully for multiple urological procedures to prevent post-operative pain. It
has also been used in obstetrical practice as a low-risk and low-cost anesthetic technique
during repair of obstetrical lacerations.
Postoperative pain after vaginal reconstructive surgery is commonly localized to the vulva,
lower vagina, and perineum, originating from the region of the sacrospinous ligament and
pelvic floor. Therefore, pudendal nerve blockage has been employed safely during pelvic
reconstructive surgery. A study comparing pudendal block with placebo after transvaginal
reconstructive surgery did not produce any differences in post-operative pain intensity or
the consumption of narcotic analgesia. However, the anesthetic used for the pudendal nerve
blockage was short-acting non-liposomal bupivacaine with a half-life of 2.7 hours.
In 2011, a liposomal formulation of bupivacaine, EXPAREL, was approved by the FDA for
single-dose infiltration in surgical site to produce postsurgical analgesia. The advantage of
using this formulation of bupivacaine is that its analgesic effects can last up to 72 hours.
Since the release of EXPAREL, there have been no published studies establishing its use for
pudendal block or the management of postoperative pain in Urogynecologic surgery.
The objective of our study is to compare the use of EXPAREL in minimizing post-operative pain
after sacrospinous ligament fixation with or without concomitant procedures for pelvic organ
prolapse, with or without suburethral sling. We hypothesize that pudendal nerve blockage
using long-acting EXPAREL will reduce post-operative pain and potentially reduce oral
narcotic consumption. It may also reduce the incidence of postoperative constipation and
patient satisfaction.
as well as analgesic requirements in the post-operative period. Pudendal nerve blockade has
been used successfully for multiple urological procedures to prevent post-operative pain. It
has also been used in obstetrical practice as a low-risk and low-cost anesthetic technique
during repair of obstetrical lacerations.
Postoperative pain after vaginal reconstructive surgery is commonly localized to the vulva,
lower vagina, and perineum, originating from the region of the sacrospinous ligament and
pelvic floor. Therefore, pudendal nerve blockage has been employed safely during pelvic
reconstructive surgery. A study comparing pudendal block with placebo after transvaginal
reconstructive surgery did not produce any differences in post-operative pain intensity or
the consumption of narcotic analgesia. However, the anesthetic used for the pudendal nerve
blockage was short-acting non-liposomal bupivacaine with a half-life of 2.7 hours.
In 2011, a liposomal formulation of bupivacaine, EXPAREL, was approved by the FDA for
single-dose infiltration in surgical site to produce postsurgical analgesia. The advantage of
using this formulation of bupivacaine is that its analgesic effects can last up to 72 hours.
Since the release of EXPAREL, there have been no published studies establishing its use for
pudendal block or the management of postoperative pain in Urogynecologic surgery.
The objective of our study is to compare the use of EXPAREL in minimizing post-operative pain
after sacrospinous ligament fixation with or without concomitant procedures for pelvic organ
prolapse, with or without suburethral sling. We hypothesize that pudendal nerve blockage
using long-acting EXPAREL will reduce post-operative pain and potentially reduce oral
narcotic consumption. It may also reduce the incidence of postoperative constipation and
patient satisfaction.
Inclusion Criteria:
- Age >18 years
- Female
- Able to give informed consent in English
- Electively scheduled for surgical management of pelvic organ prolapse involving
sacrospinous ligament fixation
Exclusion Criteria:
- Pregnant or nursing
- Allergy to amide anesthetics
- History of opioid abuse
- Severe cardiovascular, hepatic, renal disease or neurological impairment
- Long-acting opioid within 30 days or any opioid use within 24 hours before surgery
- Patients taking monoamineoxidase inhibitors (MAOI) or antidepressants of the
triptyline or imipramine types
- Administration of an investigational drug within 30 days before this study
- Chronic pain syndromes
- Daily NSAID or opioid use
- Contraindication to Non-steroidal anti-inflammatory drugs (NSAIDs)
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