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Pain ControlPhase 4NCT04769713

Hepatic Hilar Nerve Block Versus Sham in Pain Control During Liver Ablation and TACE Procedures

A Phase 4 study testing Hepatic Hilar Nerve Block Needle placement and Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block in people with Pain Control and Liver Cancer, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study is aimed at assessing the effectiveness of a novel liver specific nerve block in improving pain control during painful liver interventional radiology procedures including liver tumoral ablation and trans arterial chemoembolization, two procedures aimed at controlling liver tumors, but that can be associated… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pain Control, Liver Cancer
What is being tested?
Hepatic Hilar Nerve Block Needle placement and Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
80 participants
Where
1 siteCanada
Study dates
23 Nov 2021to 30 Sep 2023
Phase
Phase 4
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients referred to the Interventional Radiology department and approved for a chemo-embolization or radiofrequency ablation of malignant primary or secondary liver tumour.
  • At least 18 y.o.

Who cannot join

  • Patients in whom the vascular anatomy prevents safe access to the hepatic hilum or patients in whom general anaesthesia was performed.
  • Patients who have known allergy to any anaesthetic agent in the regular protocol (fentanyl, midazolam, ropivacaine).
  • Patients with signs of skin infection at the entry site of the needle used to perform the nerve block
  • Patients with signs of infection such as fever or acute increase in wight blood cell count.
  • Patients with uncorrectable abnormal coagulation status (INR >1.5 and platelets < 50000 without use of anticoagulation agents).
  • Patients with pre-existing conditions, which, in the opinion of the investigator, interfere with the conduct of the study (these reasons will be recorded)
  • Patients, who are uncooperative, cannot follow instructions, or who are unlikely to comply with follow-up appointments or fill-out the post-procedural pain questionnaires.
  • Patients with a mental state that may preclude completion of the study procedure or are unable to provide informed consent.

Trial locations and contacts

1 site in 1 country.

Louis-Martin Boucher, MD/PhD contact

514-934-1934 ext. 44454

lmboucher@yahoo.com

Canada1 site, 1 recruiting
  • McGill University Health Centre

    Montreal, Quebec, H4A 3J1

    Louis-Martin Boucher, MD/PhD, 514 934-1934 ext. 44454, lmboucher@yahoo.com

    Recruiting

Other trials in Canada

About this study

Official title: Prospective Randomized Double-Blind Study of Pain Control With Hepatic Hilum Nerve Block Versus Sham Procedure For Hepatic Chemoembolization or Radiofrequency Ablation

This study is aimed at assessing the effectiveness of a novel liver specific nerve block in improving pain control during painful liver interventional radiology procedures including liver tumoral ablation and trans arterial chemoembolization, two procedures aimed at controlling liver tumors, but that can be associated with significant pain. This novel hepatic specific nerve block was designed by us and initial retrospective results suggests it might help in controlling such liver procedural derived pain. The study was designed to compare the liver block to a sham procedure in a blinded context and to follow the participants over three days post-procedure to asses for pain levels.

Read the detailed description

This is a prospective study. Experienced interventional radiologists in the two McGill University Health Centre study centers (Royal Victoria Hospital and Montreal General Hospital) will perform all procedures:

  • 80 consecutive subjects meeting the eligibility criteria, scheduled for chemoembolization of the liver for primary or secondary liver malignancies OR radiofrequency ablation of the liver for primary or secondary liver malignancies.
  • Consent will be obtained from all patients by an interventional radiologist.
  • All procedures will be performed by a qualified interventional radiology medical doctor (IRMD).
  • Patients who accept to participate and fit the criteria will be randomized to either receive hepatic plexus block or a placebo control procedure, consisting of injection of normal saline.
  • Hepatic hilum plexus nerve block will consist of the ultrasound-guided injection of ropivacaine at the hepatic hilum anterior to the portal vein as close to the bifurcation as possible. In the sham control group, the same location will be targeted, but only normal saline will be injected.
  • A member of the radiology technologists will load the syringe with either ropivacaine or normal saline and the IRMD will thus be blinded to the patient's allocated group.
  • All patients will be offered IV analgesia using midazolam and fentanyl during the procedure at set regular intervals as per our standard regimen.
  • Similar IV analgesics as well as oral analgesics will be provided as per set orders during the recovery period in the post-procedural recovery room (PACU)
  • The patient will be discharged home with standard prescriptions for home analgesics which include routine medication and medication to be used for breakthrough pain. While at home they will be entering pain surveys three times per day for three days.
  • Data will be gathered, stored, and analyzed. The analysis will be stratified into patients who have received chemoembolization and patients who have received radiofrequency ablation.
  • Follow-up of the patient will occur as per routine 4-6 weeks post chemoembolization/radiofrequency ablation to assess the clinical success of the therapeutic procedure (ablation and TACE) and patient satisfaction with pain control.

Subject data collection on the day of the procedure will include demographics, relevant medical history, vital signs before and during the procedure, use of IV analgesics, use of oral analgesics, use of nerve block or sham procedure and visual analogue pain scales at set intervals during hospital stay. Subject data collection while at home will include visual analogue pain scale and self-recording of medication intake.

Being tested
Hepatic Hilar Nerve Block Needle placement, Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block, Injection of normal saline in the hepatic hilum for the sham procedure
Medical subject headings
Agnosia, Liver Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hepatic Hilar Nerve Block Needle placementProcedure or surgery

    Placement of a needle within 2cm of the portal vein bifurcation along its anterior surface for injection of nerve block agent (for nerve block) or saline (placebo) under US or CT guidance.

  • Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve blockDrug

    Injection of 15 ml 0.5% Ropivacaine at the hepatic hilum along the anterior surface of the portal vein within 2cm of the bifurcation.

  • Injection of normal saline in the hepatic hilum for the sham procedureDrug

    15 ml sterile normal saline is injected at the hepatic hilum along the anterior surface of the portal vein within 2cm of the bifurcation.

Study groups in NCT04769713
Study groupRoleWhat they receive
Hepatic hilar nerve block in ablation patientsExperimental15ml of 0.7% ropivacaine will be injected at the hepatic hilum anterior to the portal vein as close to the bifurcation as possible under US guidance using a 21g needle prior to the Ablation procedure.
Receives: Procedure: Hepatic Hilar Nerve Block Needle placement; Drug: Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block
Placebo procedure in ablation patientsPlacebo comparator15ml of sterile normal saline will be injected at the hepatic hilum anterior to the portal vein as close to the bifurcation as possible under US guidance using a 21g needle prior to the Ablation procedure.
Receives: Procedure: Hepatic Hilar Nerve Block Needle placement; Drug: Injection of normal saline in the hepatic hilum for the sham procedure
Hepatic hilar nerve block in chemoembolization patientsExperimental15ml of 0.7% ropivacaine will be injected at the hepatic hilum anterior to the portal vein as close to the bifurcation as possible under US guidance using a 21g needle prior to the chemoembolization procedure.
Receives: Procedure: Hepatic Hilar Nerve Block Needle placement; Drug: Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block
Placebo procedure in chemoembolization patientsPlacebo comparator15ml of sterile normal saline will be injected at the hepatic hilum anterior to the portal vein as close to the bifurcation as possible under US guidance using a 21g needle prior to the chemoembolization procedure.
Receives: Procedure: Hepatic Hilar Nerve Block Needle placement; Drug: Injection of normal saline in the hepatic hilum for the sham procedure

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in pain after a hepatic hilar nerve block during and immediately after liver ablation

    Visual analog pain score will be compared between patient having received the hepatic hilar nerve block versus those having had a placebo procedure done during the ablation procedure and while in post-anesthetic care unit. Visual analog scales are on a scale of 0-10 with 0 being no pain and 10 the worse pain imaginable.

    Measured: 1 day

  2. Changes in narcotic use after a hepatic hilar nerve block during and immediately after liver ablation

    Number of mg of narcotics used to control the pain during and immediately after the ablation while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 1 day

  3. Changes in pain after a hepatic hilar nerve block during and immediately after liver chemoembolization

    Visual analog pain score will be compared between patient having received the hepatic hilar nerve block versus those having had a placebo procedure done during the chemoembolization procedure and while in post-anesthetic care unit. Visual analog scales are on a scale of 0-10 with 0 being no pain and 10 the worse pain imaginable.

    Measured: 1 day

  4. Changes in narcotic use after a hepatic hilar nerve block during and immediately after liver chemoembolization

    Number of mg of narcotics used to control the pain during and immediately after the chemoembolization while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 1 day

Secondary outcomes (9)
  1. Changes in pain after a hepatic hilar nerve block in the early days following liver ablation

    Visual analog pain score will be compared between patient having received the hepatic hilar nerve block versus those having had a placebo procedure done up to 3 days post ablation. Visual analog scales are on a scale of 0-10 with 0 being no pain and 10 the worse pain imaginable.

    Measured: 3 days

  2. Changes in narcotic use after a hepatic hilar nerve block in the early days after liver ablation

    Number of mg of narcotics used to control the pain in the next 3 days after the ablation while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 3 days

  3. Changes in pain after a hepatic hilar nerve block in the early days following liver chemoembolization

    Visual analog pain score will be compared between patient having received the hepatic hilar nerve block versus those having had a placebo procedure done up to 3 days post chemoembolization. Visual analog scales are on a scale of 0-10 with 0 being no pain and 10 the worse pain imaginable.

    Measured: 3 days

  4. Changes in narcotic use after a hepatic hilar nerve block in the early days after liver chemoembolization

    Number of mg of narcotics used to control the pain in the next 3 days after the chemoembolization while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 3 days

  5. Changes in anti-nausea medication use after a hepatic hilar nerve block during and immediately after liver ablation

    Number of mg of anti-nausea medication used to control the pain during and immediately after the ablation while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 1 day

  6. Changes in anti-nausea medication use after a hepatic hilar nerve block during and immediately after liver chemoembolization

    Number of mg of anti-nausea medication used to control the pain during and immediately after the chemoembolization while in post-anesthetic care unit will be compared between the group having had the hepatic hilar nerve block and those having had the placebo

    Measured: 1 day

  7. Incidence of complications secondary to performing the hepatic hilar nerve block

    Incidence of complications (graded based on society of interventional radiology complication grading system) will be calculated for the various grades

    Measured: 4-6 weeks

  8. Differences in disease response post liver tumoral ablation between patients with hepatic hilar nerve block and those with sham procedure

    RECIST criteria scoring system will be used to compare treatment response on CT/MRI 4-6 weeks post liver tumoral ablation in patients having had the hepatic hilar block versus those having had the sham procedure

    Measured: 4-6 weeks

  9. Differences in disease response post liver tumoral chemoembolization between patients with hepatic hilar nerve block and those with sham procedure

    RECIST criteria scoring system will be used to compare treatment response on CT/MRI 4-6 weeks post liver tumoral chemoembolization in patients having had the hepatic hilar block versus those having had the sham procedure

    Measured: 4-6 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2021
  2. Study start23 Nov 2021
  3. Primary completion30 Jun 2023 (estimated)
  4. Study completion30 Sep 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective Randomized Double-Blinded Trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04769713
Sponsor's protocol ID
2021-7139
Status last verified
May 2023
First submitted
8 Dec 2020
Last updated
2 Jun 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No plan to share individual participant data

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Hepatic Hilar Nerve Block Needle placement and Injection of Ropivacaine in the hepatic hilum for the hepatic hilar nerve block in people with Pain Control and Liver Cancer, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 1 site in Canada.

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 2 inclusion and 8 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 Jun 2023. 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 Canada. 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?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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 Louis-Martin Boucher, MD/PhD (514-934-1934 ext. 44454, lmboucher@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in pain after a hepatic hilar nerve block during and immediately after liver ablation (time frame: 1 day). The study lists 4 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 Jun 2023.

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