Postoperative PainEarly Phase 1NCT04728308
Bupivacaine Infiltration and Postoperative Pain
A Early Phase 1 study testing Bupivacain in people with Postoperative Pain and Local Infiltration, run by Armed Forces Hospital, Pakistan at 1 site in Pakistan.
Trial summary
This is a double-blind randomized controlled trial to assess the efficacy of local infiltration of bupivacaine versus placebo, in reducing postoperative pain. The severity of pain will be assessed in terms of mean score on visual analogue scale, opioid requirement and average duration of hospital stay. Read more about this study
- Who is it for?
- Ages 20 to 40 years, women only
- Conditions the study is for
- Postoperative Pain, Local Infiltration, Analgesia
- What is being tested?
- Bupivacain
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 300 participants
- Where
- 1 sitePakistan
- Study dates
- 10 Jan 2021to 10 Apr 2021
- Phase
- Early Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- Women only
- No healthy volunteers
- Adult
Who may be able to join
- pregnant women with age between 20-40 years, American Society of Anesthesiologist (ASA) class II, BMI < 35 at the time of surgery, a period of gestation 37+0- 40+0 weeks, elective caesarean section done under spinal anesthesia, skin incision pfennensteil and lower segment transverse incision on the uterus.
Who cannot join
- allergy to local anesthetic, emergency caesarean section, conversion of spinal anesthesia to general anesthesia, caesarean section due to abnormal placentation, midline skin incision, upper segment incision on uterus
Trial locations and contacts
1 site in 1 country.
Arshad Khushdil contact
Pakistan1 site, 1 recruiting
- Recruiting
Madiha Ahmed
Islamabad, 45710
Madiha Ahmed, madiha940@yahoo.com
About this study
Official title: Does Bupivacaine Infiltration Reduce Postoperative Pain in Patients With Cesarean Section?
This is a double-blind randomized controlled trial to assess the efficacy of local infiltration of bupivacaine versus placebo, in reducing postoperative pain. The severity of pain will be assessed in terms of mean score on visual analogue scale, opioid requirement and average duration of hospital stay.
Read the detailed description
Objective: To compare the effect of bupivacaine wound infiltration with placebo during caesarean section in terms of mean pain scores, analgesic requirement, and duration of hospital stay
Introduction:
Over the last several decades, the rate of caesarean has increased rapidly.According to the data collected from 150 countries, almost 18.6% of the total births occur by caesareansection, with rates ranging from 6% to 27% in different regions. In Egypt and Turkey, the rate of caesarean section is more than 50%. In Pakistan, caesarean section rate was found to be 15.8% in 2013, with a rate of 11.5% in rural areas and 25.6% in the urban population.
Caesarean section is the most commonly performed surgical procedure nowadays and is associated with moderate to severe pain after the surgery. Pain after caesarean section occurs due to inadvertent damage to parietal peritoneum and nerve supply of skin.According to a survey done in America in 2003, it was found that upto 70% of the patients will experience severe pain postoperatively. Severe pain after caesarean section specifically affects mother-baby bonding, lactation, and patient recovery. It also leads to a prolonged hospital stay, reduced mobility, and consequently increasing the risk of thromboembolic disease in the postoperative period. Severe pain aftercaesarean delivery has also been found to be associated with postnatal depression and pain persisting after 8 weeks of delivery.Incaesarean delivery, the provision of effective postoperative analgesia is of key importance to facilitate early ambulation and infant care. It is also very important that the type of analgesia providedis safe, effective,and has minimal side effects for the mother and her baby.
The most appropriate method of analgesia for postoperative pain after caesarean section remains uncertain.Different methods have been used for this purpose. Parenteral opioids are the most commonly used method but associated nausea, vomiting, sedation, and risk of respiratory depression in mother and baby limits its use. Continuous epidural analgesia or patient-controlled analgesia also provide effective analgesia and have fewer adverse effects butare expensive and require special equipment and expertise.Infiltration of local anesthetic into subcutaneous tissue around the incision site has also been thought to relieve pain after caesarean section. Local anesthetic drugslike lignocaine and bupivacaine inhibit nerve impulses from the site of injury thus providing an analgesic effect. However,in this regard, there is no consistent evidence.Some studies show high efficacy while others report no benefit.
This study is being conducted to assess the effectiveness of wound infiltration of 20ml of 0.5% bupivacaine after the caesarean section on postoperative pain scores and analgesic requirement. If found effective this regimen can be implemented locally as it is cheap and simple to use.
Method: This will be a a double-blind randomized controlled trial. It is being conducted at the Department of Gynecology and Obstetrics, Pak Emirates Military Hospital from 10th January 2020 and will be completed till 10th april 2021. Pregnant women at term, with ages between 20 to 40 years, who are planned to undergo elective caesarean section, will included in the study. Patients are divided into two groups by a computer-generated lottery method. In group A, 20 ml of sterile water is infiltrated in the subcutaneous tissue around the incision site while 20 ml of 0.5% bupivacaine injection is infiltrated in patients of group B. The primary outcome measure is to asses the difference in postoperative pain among the two groups in terms of average pain score measure with help of visual analogue scale (VAS) and total dose of analgesia required in the first twenty four hours after the surgery. Secondary outcome is the average duration of hospital stay in patients of the two groups All the data will be entered and analyzed with help of SPSS version 16. For quantitative variables like mean pain score, average dose of opioid required, and average duration of hospital stay, the investigators will calculate mean and standard deviation and for qualitative variables like indication of the caesarean section, frequency and percentage will be calculated. To compare the quantitative variables between the two groups, unpaired T-test and for comparison of qualitative variables, chi-square test will be used. A p-value of <0.05 will be considered significant.
- Conditions
- Postoperative Pain, Local Infiltration, Analgesia
- Being tested
- Bupivacain
- Keywords
- Bupivacaine, Local anesthetic, cesarean section
- Medical subject headings
- Pain, Postoperative, Agnosia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
BupivacainDrug
Before closing the skin incision,Infiltration of 20ml of 0.5% bupivacaine around incision site will be done in the patients of experimental group and 20 ml of distill water will be infiltrated in the pateints of the placebo group
| Study group | Role | What they receive |
|---|---|---|
| Experimental group | Active comparator | 20ml of 0.5% bupivacaine is infiltrated in the subcutaneous tissue around the incision site Receives: Drug: Bupivacain |
| Placebo group | Placebo comparator | 20 ml of distill water is infiltrated in the subcutaneous tissue around the incision site Receives: Drug: Bupivacain |
What is being measured
The primary outcome is the main question the study is designed to answer.
average pain score on Visual analogue scale
average pain score on Visual analogue scale in first 12 hours after the surgery
Measured: in first 12 hours after the surgery
average opioid consumption
average consumption of tramadol injection
Measured: within first 24 hours after the surgery
Secondary outcomes (1)
average duration of hospital stay
average duration of hospital stay after the surgery
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jan 2021
- Study start10 Jan 2021
- Primary completion10 Apr 2021 (estimated)
- Study completion10 Apr 2021 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Postoperative PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Early Phase 1
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Informed written consent will be taken. Patients will be divided into two groups randomly, by a computer-generated method. Caesarean section will be done under spinal anesthesia by a well-trained consultant obstetrician. The surgeon will be provided with a 20 ml syringe filled either with 20 ml of 0.5% Bupivacaine or 20 ml of placebo (distill water). The syringe will be prepared by our researcher obstetrician. The contents of the syringe will be determined by numbers generated from the computer and the operating surgeon will be unaware of these contents. Before closing the skin incision, the operating surgeon will infiltrate the solution in subcutaneous tissue around the incision.
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Outcomes assessor
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Armed Forces Hospital, Pakistan
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, arshad khushdil, Armed Forces Hospital, Pakistan
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04728308
- Sponsor's protocol ID
- A/28/EC/232/2021
- Status last verified
- Jan 2021
- First submitted
- 24 Jan 2021
- Last updated
- 2 Feb 2021
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Feb 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Does Bupivacaine Infiltration Reduce Postoperative Pain in Patients With Cesarean Section?
- ClinicalTrials.gov ID
- NCT04728308
- Acronym / sponsor ID
- A/28/EC/232/2021
- Conditions
- Postoperative Pain, Local Infiltration, Analgesia
- Keywords
- Bupivacaine, Local anesthetic, cesarean section
- Phase
- Early Phase 1
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- Armed Forces Hospital, PakistanUniversity, hospital or other
- Study start
- 10 Jan 2021 (actual)
- Primary completion
- 10 Apr 2021 (estimated)
- Study completion
- 10 Apr 2021 (estimated)
- First posted
- 28 Jan 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a double-blind randomized controlled trial to assess the efficacy of local infiltration of bupivacaine versus placebo, in reducing postoperative pain. The severity of pain will be assessed in terms of mean score on visual analogue scale, opioid requirement and average duration of hospital stay.
Detailed description
Objective: To compare the effect of bupivacaine wound infiltration with placebo during caesarean section in terms of mean pain scores, analgesic requirement, and duration of hospital stay
Introduction:
Over the last several decades, the rate of caesarean has increased rapidly.According to the data collected from 150 countries, almost 18.6% of the total births occur by caesareansection, with rates ranging from 6% to 27% in different regions. In Egypt and Turkey, the rate of caesarean section is more than 50%. In Pakistan, caesarean section rate was found to be 15.8% in 2013, with a rate of 11.5% in rural areas and 25.6% in the urban population.
Caesarean section is the most commonly performed surgical procedure nowadays and is associated with moderate to severe pain after the surgery. Pain after caesarean section occurs due to inadvertent damage to parietal peritoneum and nerve supply of skin.According to a survey done in America in 2003, it was found that upto 70% of the patients will experience severe pain postoperatively. Severe pain after caesarean section specifically affects mother-baby bonding, lactation, and patient recovery. It also leads to a prolonged hospital stay, reduced mobility, and consequently increasing the risk of thromboembolic disease in the postoperative period. Severe pain aftercaesarean delivery has also been found to be associated with postnatal depression and pain persisting after 8 weeks of delivery.Incaesarean delivery, the provision of effective postoperative analgesia is of key importance to facilitate early ambulation and infant care. It is also very important that the type of analgesia providedis safe, effective,and has minimal side effects for the mother and her baby.
The most appropriate method of analgesia for postoperative pain after caesarean section remains uncertain.Different methods have been used for this purpose. Parenteral opioids are the most commonly used method but associated nausea, vomiting, sedation, and risk of respiratory depression in mother and baby limits its use. Continuous epidural analgesia or patient-controlled analgesia also provide effective analgesia and have fewer adverse effects butare expensive and require special equipment and expertise.Infiltration of local anesthetic into subcutaneous tissue around the incision site has also been thought to relieve pain after caesarean section. Local anesthetic drugslike lignocaine and bupivacaine inhibit nerve impulses from the site of injury thus providing an analgesic effect. However,in this regard, there is no consistent evidence.Some studies show high efficacy while others report no benefit.
This study is being conducted to assess the effectiveness of wound infiltration of 20ml of 0.5% bupivacaine after the caesarean section on postoperative pain scores and analgesic requirement. If found effective this regimen can be implemented locally as it is cheap and simple to use.
Method: This will be a a double-blind randomized controlled trial. It is being conducted at the Department of Gynecology and Obstetrics, Pak Emirates Military Hospital from 10th January 2020 and will be completed till 10th april 2021. Pregnant women at term, with ages between 20 to 40 years, who are planned to undergo elective caesarean section, will included in the study. Patients are divided into two groups by a computer-generated lottery method. In group A, 20 ml of sterile water is infiltrated in the subcutaneous tissue around the incision site while 20 ml of 0.5% bupivacaine injection is infiltrated in patients of group B. The primary outcome measure is to asses the difference in postoperative pain among the two groups in terms of average pain score measure with help of visual analogue scale (VAS) and total dose of analgesia required in the first twenty four hours after the surgery. Secondary outcome is the average duration of hospital stay in patients of the two groups All the data will be entered and analyzed with help of SPSS version 16. For quantitative variables like mean pain score, average dose of opioid required, and average duration of hospital stay, the investigators will calculate mean and standard deviation and for qualitative variables like indication of the caesarean section, frequency and percentage will be calculated. To compare the quantitative variables between the two groups, unpaired T-test and for comparison of qualitative variables, chi-square test will be used. A p-value of <0.05 will be considered significant.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, outcomes assessor)
- Number of arms
- 2
- Model description
- Informed written consent will be taken. Patients will be divided into two groups randomly, by a computer-generated method. Caesarean section will be done under spinal anesthesia by a well-trained consultant obstetrician. The surgeon will be provided with a 20 ml syringe filled either with 20 ml of 0.5% Bupivacaine or 20 ml of placebo (distill water). The syringe will be prepared by our researcher obstetrician. The contents of the syringe will be determined by numbers generated from the computer and the operating surgeon will be unaware of these contents. Before closing the skin incision, the operating surgeon will infiltrate the solution in subcutaneous tissue around the incision.
| Arm | Type | Receives |
|---|---|---|
| Experimental group | Active comparator | Drug: Bupivacain20ml of 0.5% bupivacaine is infiltrated in the subcutaneous tissue around the incision site |
| Placebo group | Placebo comparator | Drug: Bupivacain20 ml of distill water is infiltrated in the subcutaneous tissue around the incision site |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- pregnant women with age between 20-40 years, American Society of Anesthesiologist (ASA) class II, BMI < 35 at the time of surgery, a period of gestation 37+0- 40+0 weeks, elective caesarean section done under spinal anesthesia, skin incision pfennensteil and lower segment transverse incision on the uterus.
Key exclusion criteria (1 listed)
- allergy to local anesthetic, emergency caesarean section, conversion of spinal anesthesia to general anesthesia, caesarean section due to abnormal placentation, midline skin incision, upper segment incision on uterus
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| BupivacainBefore closing the skin incision,Infiltration of 20ml of 0.5% bupivacaine around incision site will be done in the patients of experimental group and 20 ml of distill water will be infiltrated in the pateints of the placebo group | Drug | Experimental group, Placebo group |
Primary outcome
average pain score on Visual analogue scale
Time frame: in first 12 hours after the surgery
average pain score on Visual analogue scale in first 12 hours after the surgery
average opioid consumption
Time frame: within first 24 hours after the surgery
average consumption of tramadol injection
1 secondary outcome
average duration of hospital stay
Time frame: 3 months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Feb 2021.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Arshad Khushdil contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Early Phase 1 study testing Bupivacain in people with Postoperative Pain and Local Infiltration, run by Armed Forces Hospital, Pakistan at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 2 Feb 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Madiha Ahmed (923345366225, madiha940@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
average pain score on Visual analogue scale (time frame: in first 12 hours after the surgery). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Feb 2021.