Randomized double blind placebo controlled trial to compare the post-operative pain control advantages of post-incisional wound infiltration with liposomal bupivacaine to plain bupivacaine in patients presenting for elective caesarean delivery.
Participants will include women with uncomplicated singleton pregnancies, ≥37 weeks gestation, ≥18 years old presenting and presenting for elective caesarean delivery with a planned spinal anesthetic with a standardized amount of intrathecal morphine (ITM). Exclusion criteria include patients: not receiving a spinal anesthetic, receiving a spinal anesthetic that required supplemental intraoperative pain medications (ketamine, epidural narcotics, intravenous narcotics, etc), on chronic opioids, American Society of Anesthesiologist (ASA) physical status class III or higher (Note: An ASA I patient is defined as a normal healthy patient, an ASA II patient is defined as a patient with mild systemic disease and any patient that with severe systemic disease or a disease that is incapacitating would be classified as an ASA III or higher) or those that have known hypersensitivity to bupivacaine hydrochloride, amide-type local anesthetics, or any component of the formation, and any subject with hepatic or renal impairment. A three-arm study will be used: (a) control group (placebo of normal saline) (b) plain bupivacaine group and (c) liposomal bupivacaine group. After patients receive their spinal anesthetic and as the Pfannenstiel incision is being closed, an equal volume (20ml, administered via two 10ml syringes) of one of the three solutions will be infiltrated into the wound by the obstetrician team in a standardized fashion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
132
After patients receive their spinal anesthetic and as the Pfannenstiel incision is being closed, an equal volume (20ml, administered via two 10ml syringes) of bupivacaine 0.5% plain will be infiltrated into the wound by the obstetrician team in a standardized fashion.
After patients receive their spinal anesthetic and as the Pfannenstiel incision is being closed, an equal volume (20ml, administered via two 10ml syringes) of one liposomal bupivacaine will be infiltrated into the wound by the obstetrician team in a standardized fashion.
After patients receive their spinal anesthetic and as the Pfannenstiel incision is being closed, an equal volume (20ml, administered via two 10ml syringes) of normal saline will be infiltrated into the wound by the obstetrician team in a standardized fashion.
Brooke Army Medical Center
Fort Sam Houston, Texas, United States
RECRUITINGPost-operative Analgesia
VAS pain intensity scores (at rest)
Time frame: Thru 24 hours
Post-operative Analgesia
VAS pain intensity scores (at rest)
Time frame: Thru 48 hours
Opioid use in the post-operative period
Post-operative opioid consumption
Time frame: Thru 72 hours
Length of Stay (LOS)
Reduction in LOS
Time frame: Thru 72 hours
Time to first ambulation
Time to ambulation
Time frame: Thru 72 hours
Breast feeding initiation
Time to breast feeding initiation
Time frame: Thru 72 hours
Sole breastfeeding
Percentage of subjects solely breastfeeding at the time of discharge
Time frame: Thru 72 hours
Increased operative time
Increased operative time for cesarean delivery
Time frame: Thru 72 hours
Pain control at 2 hours post-cesarean delivery
VAS pain intensity at 2 hours
Time frame: Thru 2 hours
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Wound Complication
Wound complication
Time frame: 14days post-operatively