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Gender DysphoriaPhase 3NCT04979338

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

A Phase 3 study testing Ultrasound guided Continuous Infraclavicular Brachial Plexus Block, Ultrasound guided Continuous Femoral Nerve Block and Ultrasound guided Pudendal Nerve Block in people with Gender Dysphoria, run by Cedars-Sinai Medical Center at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

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. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Gender Dysphoria
What is being tested?
Ultrasound guided Continuous Infraclavicular Brachial Plexus Block, Ultrasound guided Continuous Femoral Nerve Block and Ultrasound guided Pudendal Nerve Block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
640 participants
Where
1 siteUnited States
Study dates
11 Nov 2021to 30 Sep 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

  • 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)

Who cannot join

  • Patients who do not meet the inclusion criteria above
  • 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

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Jenna Stelmar, BS contact

805-813-7882

jenna.stelmar@cshs.org

United States1 site, 1 recruiting
  • Cedars-Sinai Medical Center - North and South Towers

    Los Angeles, California, 90048

    Maurice M Garcia, M.D., MAS, 310-423-4256, maurice.garcia@csmc.edu

    Recruiting

Other trials in United States

About this study

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.

Being tested
Ultrasound guided Continuous Infraclavicular Brachial Plexus Block, Ultrasound guided Continuous Femoral Nerve Block, Ultrasound guided Pudendal Nerve Block, Bupivacaine, Bilateral ultrasound guided Transversus Abdominis Plane Block
Keywords
Gender Dysphoria, Gender-Affirming Surgery, Peri-Operative Pain, Pain Management, Surgery Pain, Sex Reassignment Surgery, Gender Reassignment Surgery, Vaginoplasty, Phalloplasty, Quality Improvement, Opioid Use
Medical subject headings
Gender Dysphoria, Agnosia

What participants receive

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

  • Ultrasound guided Continuous Infraclavicular Brachial Plexus BlockOther

    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 BlockOther

    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 BlockOther

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

  • BupivacaineDrug

    Also called Marcaine

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

  • Bilateral ultrasound guided Transversus Abdominis Plane BlockOther

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

  • Bilateral spermatic cord blockOther

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

  • Pecs I & II BlockOther

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

  • Local anestheticOther

    0.25% or 0.5% bupivacaine into the appropriate surgical site

Study groups in NCT04979338
Study groupRoleWhat they receive
Surgery-specific general anesthetic + ultrasound guided peripheral nerve block #1Active comparatorDepending 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)
Receives: Other: Ultrasound guided Continuous Infraclavicular Brachial Plexus Block; Other: Ultrasound guided Continuous Femoral Nerve Block; Other: Ultrasound guided Pudendal Nerve Block; Drug: Bupivacaine; Other: Bilateral spermatic cord block; Other: Pecs I & II Block; Other: Local anesthetic
Surgery-specific general anesthetic + ultrasound guided peripheral nerve block #2Active comparatorDepending 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)
Receives: Drug: Bupivacaine; Other: Bilateral ultrasound guided Transversus Abdominis Plane Block; Other: Local anesthetic
Surgery-specific general anesthetic + local anesthetic at incision siteActive comparatorDepending 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)
Receives: Drug: Bupivacaine; Other: Bilateral spermatic cord block; Other: Local anesthetic

What is being measured

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

  1. Changes in peri-operative pain location and intensity over time, as measured by anatomic pain maps

    Anterior and posterior illustrations of the body, with pre-defined areas involved in surgery that may be circled, will be used to define pain location. Pain scores for each circled area will be measured on a Likert-scale between 0-10, with 0 indicating no pain and 10 indicating the worst pain experienced in respondent's life.

    Measured: Any time pain is experienced, starting on the morning of post-operative Day 1 to End of Study at the final post-operative visit (average of 30 days after surgery)

  2. Changes in opioid consumption per 24 hours, measured by total inpatient and total outpatient

    Inpatient opioid consumption will be obtained from hospital records. Outpatient opioid consumption will be determined from completed medication logs. Opioid consumption will be measured per 24 hours, by hospital location (e.g., PACU versus Ward), and by post-operative day.

    Measured: Per 24 hours, starting on post-operative Day 1 to End of Study at the final post-operative visit (average of 30 days after surgery)

  3. Change in the opioid side effect of urinary retention, as indicated by time to spontaneous voiding

    Recorded time to spontaneous voiding will be collected from hospital records.

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  4. Change in the opioid side effect of urinary retention, as measured by a Urinary Bother Symptom Score Questionnaire

    A Urinary Bother Symptom Score Questionnaire, obtained from the American Urological Association, will assess the frequency of different urinary problems, such as incomplete emptying, intermittency, and urgency. Each urinary problem will be measured on a scale from 0 to 5, with 0 indicating "none/not at all" and 5 indicating "almost always."

    Measured: Pre-operative visit, Discharge (average of 7 days after surgery), and End of Study/final post-operative visit (average of 30 days after surgery)

  5. Change in the opioid side effect of decreased GI motility and ileus, as indicated by number of post-operative days until commencement of regular passage of flatus

    Recorded number of post-operative days until commencement of regular passage of flatus will be obtained from hospital records.

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  6. Change in the opioid side effect of nausea, as indicated by number of post-operative days to toleration of liquid diet and regular diet, as well as reported experience of nausea

    Recorded number of post-operative days and experience of nausea will be obtained from hospital records.

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  7. Post-operative length of inpatient stay

    Length of inpatient stay will be obtained from hospital records as the recorded number of days spent inpatient after surgery

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  8. Global satisfaction with respect to pain and physical comfort, as measured by a Quality of Recovery 15-Item Inventory

    Questions 1-10 will assess global well-being and physical comfort, such as ability to return to work or usual home activities, feeling rested, ability to enjoy food, and general feelings of well-being. These questions will be rated on a scale of 0 to 10, with 0 indicating none of the time (poor) and 10 indicating all of the time (excellent).

    Questions 11-15 will assess pain and physical comfort, such as presence of moderate/severe pain, nausea or vomiting, worried or anxious feelings, and sad or depressed feelings. These questions will be rated on a scale of 0 to 10, with 0 indicating all of the time (poor) and 10 indicating none of the time (excellent).

    Measured: Daily, starting on the morning of post-operative Day 1 to End of Study at the final post-operative visit (average of 30 days after surgery)

  9. Frequency of treatment complications

    Treatment complications, such as hematoma, infection, etc., will only include those that are determined to be related to the study treatment.

    Measured: End of study (average of 30 days after surgery)

Secondary outcomes (3)
  1. Time to mobilization

    The recorded number of days to mobilization will be obtained from hospital records.

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  2. Time to first day of bowel movement

    The recorded number of days to first bowel movement will be obtained from hospital records.

    Measured: Post-operative Day 1 to Discharge (average of 7 days after surgery)

  3. Number of participants with any hospital readmission within 30 days of discharge

    Measured: 30 days after Day of Discharge (average of 7 days after surgery)

Timeline

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

  1. First posted28 Jul 2021
  2. Study start11 Nov 2021
  3. Primary completion30 Sep 2026 (estimated)
  4. Study completion30 Sep 2026 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
640 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04979338
Sponsor's protocol ID
STUDY00000879
Status last verified
Sep 2025
First submitted
2 Jul 2021
Last updated
17 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Ultrasound guided Continuous Infraclavicular Brachial Plexus Block, Ultrasound guided Continuous Femoral Nerve Block and Ultrasound guided Pudendal Nerve Block in people with Gender Dysphoria, run by Cedars-Sinai Medical Center at 1 site in United States.

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 5 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: looking for participants now, as of the sponsor's last update on 17 Sep 2025. 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 United States. 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. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jenna Stelmar, BS (805-813-7882, jenna.stelmar@cshs.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in peri-operative pain location and intensity over time, as measured by anatomic pain maps (time frame: Any time pain is experienced, starting on the morning of post-operative Day 1 to End of Study at the final post-operative visit (average of 30 days after surgery)). The study lists 9 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 17 Sep 2025.

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