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Efficacy and Safety of a Collagen Bupivacaine Implant in Women Following Abdominal Hysterectomy

Primary Purpose

Postoperative Pain

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bupivacaine Collagen Sponge (CollaRx®)
placebo
Sponsored by
Innocoll
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Postoperative Pain focused on measuring Post Operative Pain, Hysterectomy

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Have a body mass index (BMI) > 19 and < 40 kg/m2
  • Had planned an elective total abdominal hysterectomy for reasons other than malignancies to be performed according to standard surgical technique using a standard incision and under general anesthesia with the following caveats:

    1. Laparoscopic procedures or supraumbilical or Maylard incisions will not be allowed
    2. A nonlaparoscopic incision for benign non-hysterectomy gynecological procedures (such as myomectomy or adnexal surgery) is acceptable if the surgical indication is not to treat pelvic pain
    3. No concomitant vaginal procedures are allowed. An abdominal urethropexy and an incidental appendectomy will be allowed
  • Have a risk classification of I, II or III according to the American Society of Anesthesiologists (ASA)
  • Have a negative pregnancy test
  • Be free of other physical or mental conditions which may confound assessment of postoperative pain
  • Have the ability to read, understand and comply with the study procedures and the use of the pain scales; is capable of operating a patient-controlled analgesia (PCA) device; and is able to communicate meaningfully with the study staff
  • Voluntarily sign and date an informed consent form (ICF), prior to the conduct of any study-specific procedures
  • Able to fluently speak and understand English and be able to provide meaningful written informed consent for the study

Exclusion Criteria:

  • Known hypersensitivity to any active or inactive ingredient of the test articles
  • Presence of clinically significant cardiac arrhythmias or atrioventricular (AV) conduction disorders
  • Concomitant use of other amide local anesthetics
  • Concomitant use of antiarrhythmics
  • Concomitant use of propanolol
  • Concomitant use of strong/moderate CYP3A4 inhibitors or inducers
  • Has used aspirin or aspirin-containing products within 7 days of surgery.
  • Previous major surgery in the last 3 months
  • Requires any additional surgical procedures during the same hospitalization (except as noted)
  • Received neuraxial (spinal or epidural) opioid analgesics either prior to or during surgery
  • Received local anesthetic infiltration of the surgical wound prior to, during or immediately after closure
  • Is scheduled to receive local anesthetics via an indwelling catheter after surgery
  • Underwent additional procedures during surgery, which may increase the visceral pain
  • Has known or suspected history of alcohol or drug abuse or misuse or evidence for tolerance or physical dependency on opioids analgesics or sedative-hypnotic medications
  • Uses opioids or tramadol daily for > 7 days prior to test article administration
  • Has impaired liver function
  • Has any clinically significant unstable condition that could compromise the patient's welfare
  • Is at risk for infection or slow wound healing
  • Has a chronic painful condition that might confound the assessment of pain associated with the sugery
  • Has taken pain medication that could confound the analgesic responses the day of surgery
  • Has been treated within 2 weeks of surgery with agents that could affect the analgesic response
  • Has been treated with monoamine oxidase inhibitors (MAOIs) or MAOIs have been stopped fewer than 10 days prior to surgery
  • Has been treated with corticosteroids or whose treatment with these has been stopped < 7 days prior surgery (inhaled corticosteroids are acceptable)
  • Has participated in a clinical trial in the previous 30 days
  • Has been hemodynamically unstable at any point in the previous 4 weeks or becomes hemodynamically unstable during surgery
  • Required blood transfusion in the previous month, except as related to uterine bleeding caused by uterine fibroids.
  • Has hemoglobin levels < 10 g/dL or < 8 g/dL for patients with an anemia secondary to heavy uterine bleeding caused by uterine fibroids.
  • Has platelet count < 100,000/mm
  • Unreliable or incapable of complying with the protocol

Sites / Locations

  • Forsyth Medical Centre - OB Anesthesia

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

No Intervention

Arm Label

1

2

3

Arm Description

A total of three 5 × 5-cm bupivacaine sponges implanted at specified layers in the wound prior to wound closure

A total of three 5 × 5-cm collagen sponges implanted at specified layers in the wound prior to wound closure

The patient will recieve the standard of care, but no implant during surgery

Outcomes

Primary Outcome Measures

Total Use of Opioid Rescue Analgesia
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome

Secondary Outcome Measures

Total Use of Opioid Rescue Analgesia
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome
Total Use of Opioid Rescue Analgesia
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome
Pain Intensity Rating on a Visual Analog Scale (at Rest)
Pain intensity rating on a Visual Analog Scale (at rest). Lowest score possible is "0" with the highest score possible being "100". Higher number means more pain reported.
Time to First Use of Opioid Rescue Analgesia
Time to first use of opioid rescue analgesia - lower number means worse outcome
Pain Intensity Rating on a Visual Analog Scale (After Cough)
Pain intensity rating on a Visual Analog Scale (after cough). Lowest score possible is "0" with the highest score possible being "100". Higher number means more pain reported.
Pain Intensity Rating on a 4-point Likert Scale (at Rest)
For the 4-point categorical scale assessment, patients measured their pain intensity at rest using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."
Pain Intensity Rating on a 4-point Likert Scale (After Cough)
For the 4-point categorical scale assessment, patients measured their pain intensity after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."

Full Information

First Posted
February 19, 2008
Last Updated
July 21, 2021
Sponsor
Innocoll
Collaborators
Premier Research Group plc
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1. Study Identification

Unique Protocol Identification Number
NCT00624910
Brief Title
Efficacy and Safety of a Collagen Bupivacaine Implant in Women Following Abdominal Hysterectomy
Official Title
A Phase II, Single-dose, Blinded, Prospective Study to Investigate the Efficacy and Safety of the CollaRx® Bupivacaine Implant in Women Following Abdominal Hysterectomy or Other Nonlaparoscopic Benign Gynecological Procedure
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
December 27, 2007 (Actual)
Primary Completion Date
September 5, 2008 (Actual)
Study Completion Date
September 5, 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Innocoll
Collaborators
Premier Research Group plc

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine whether the CollaRx Bupivacaine implant is safe and effective in reducing the amount of narcotic pain medication needed to control pain during the first 24 hours after abdominal hysterectomy surgery.
Detailed Description
Hysterectomy is the second most common surgery among women in the United States (US). According to the National Center for Health Statistics, there were 617,000 hysterectomies performed in the US in 2004. Effective postoperative pain management after hysterectomy is important in ensuring that surgical subjects have a smooth and successful recovery after their operation. Morphine and other narcotic pain medications are often used to help control pain after hysterectomy, but the large quantities required can lead to fatigue, nausea and vomiting, as well as the inability to walk around much because of drowsiness. Reducing narcotic pain medication use can reduce these negative side effects. Bupivacaine is a local anesthetic (pain medicine) that has an established safety profile. Collagen is a protein that is found in all mammals. The CollaRx Bupivacaine implant is a thin flat sponge made out of collagen that comes from cow tendons and contains bupivacaine. When inserted into a surgical site, the collagen breaks down and bupivacaine is released at the site but very little is absorbed into the blood stream. The high levels of bupivacaine at the surgical site may result in less pain for several days after surgery. This study will compare the amount of narcotic pain medication required after surgery in patients who receive the CollaRx Bupivacaine implant, a plain collagen implant or no implant at all.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Postoperative Pain
Keywords
Post Operative Pain, Hysterectomy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
54 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
A total of three 5 × 5-cm bupivacaine sponges implanted at specified layers in the wound prior to wound closure
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
A total of three 5 × 5-cm collagen sponges implanted at specified layers in the wound prior to wound closure
Arm Title
3
Arm Type
No Intervention
Arm Description
The patient will recieve the standard of care, but no implant during surgery
Intervention Type
Drug
Intervention Name(s)
Bupivacaine Collagen Sponge (CollaRx®)
Other Intervention Name(s)
CollRx Bupivacaine Implant
Intervention Description
The bupivacaine sponge contains 70 mg Type I collagen and 50 mg bupivacaine hydrochloride. A total of 3 sponges will be implanted during surgery; one sponge divided between areas in the vault, one sponge divided and placed across the incision in the peritoneum and the final sponge divided and placed between the sheath and skin around the incision.
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
The placebo sponge contains 70 mg Type I collagen. A total of 3 sponges will be implanted during surgery; one sponge divided between areas in the vault, one sponge divided and placed across the incision in the peritoneum and the final sponge divided and placed between the sheath and skin around the incision.
Primary Outcome Measure Information:
Title
Total Use of Opioid Rescue Analgesia
Description
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome
Time Frame
0 to 24 hours postoperatively
Secondary Outcome Measure Information:
Title
Total Use of Opioid Rescue Analgesia
Description
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome
Time Frame
0 to 48 hours postoperatively
Title
Total Use of Opioid Rescue Analgesia
Description
Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome
Time Frame
0 to 72 hours postoperatively
Title
Pain Intensity Rating on a Visual Analog Scale (at Rest)
Description
Pain intensity rating on a Visual Analog Scale (at rest). Lowest score possible is "0" with the highest score possible being "100". Higher number means more pain reported.
Time Frame
At 1, 1.5, 2, 3, 6, 9, 12, 18, 24, 36, 48 and 72 hours post operatively
Title
Time to First Use of Opioid Rescue Analgesia
Description
Time to first use of opioid rescue analgesia - lower number means worse outcome
Time Frame
Actual time assessed during post operative period
Title
Pain Intensity Rating on a Visual Analog Scale (After Cough)
Description
Pain intensity rating on a Visual Analog Scale (after cough). Lowest score possible is "0" with the highest score possible being "100". Higher number means more pain reported.
Time Frame
At 1, 1.5, 2, 3, 6, 9, 12, 18, 24, 36, 48 and 72 hours post operatively
Title
Pain Intensity Rating on a 4-point Likert Scale (at Rest)
Description
For the 4-point categorical scale assessment, patients measured their pain intensity at rest using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."
Time Frame
At 1, 1.5, 2, 3, 6, 9, 12, 18, 24, 36, 48 and 72 hours post operatively
Title
Pain Intensity Rating on a 4-point Likert Scale (After Cough)
Description
For the 4-point categorical scale assessment, patients measured their pain intensity after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."
Time Frame
At 1, 1.5, 2, 3, 6, 9, 12, 18, 24, 36, 48 and 72 hours post operatively

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have a body mass index (BMI) > 19 and < 40 kg/m2 Had planned an elective total abdominal hysterectomy for reasons other than malignancies to be performed according to standard surgical technique using a standard incision and under general anesthesia with the following caveats: Laparoscopic procedures or supraumbilical or Maylard incisions will not be allowed A nonlaparoscopic incision for benign non-hysterectomy gynecological procedures (such as myomectomy or adnexal surgery) is acceptable if the surgical indication is not to treat pelvic pain No concomitant vaginal procedures are allowed. An abdominal urethropexy and an incidental appendectomy will be allowed Have a risk classification of I, II or III according to the American Society of Anesthesiologists (ASA) Have a negative pregnancy test Be free of other physical or mental conditions which may confound assessment of postoperative pain Have the ability to read, understand and comply with the study procedures and the use of the pain scales; is capable of operating a patient-controlled analgesia (PCA) device; and is able to communicate meaningfully with the study staff Voluntarily sign and date an informed consent form (ICF), prior to the conduct of any study-specific procedures Able to fluently speak and understand English and be able to provide meaningful written informed consent for the study Exclusion Criteria: Known hypersensitivity to any active or inactive ingredient of the test articles Presence of clinically significant cardiac arrhythmias or atrioventricular (AV) conduction disorders Concomitant use of other amide local anesthetics Concomitant use of antiarrhythmics Concomitant use of propanolol Concomitant use of strong/moderate CYP3A4 inhibitors or inducers Has used aspirin or aspirin-containing products within 7 days of surgery. Previous major surgery in the last 3 months Requires any additional surgical procedures during the same hospitalization (except as noted) Received neuraxial (spinal or epidural) opioid analgesics either prior to or during surgery Received local anesthetic infiltration of the surgical wound prior to, during or immediately after closure Is scheduled to receive local anesthetics via an indwelling catheter after surgery Underwent additional procedures during surgery, which may increase the visceral pain Has known or suspected history of alcohol or drug abuse or misuse or evidence for tolerance or physical dependency on opioids analgesics or sedative-hypnotic medications Uses opioids or tramadol daily for > 7 days prior to test article administration Has impaired liver function Has any clinically significant unstable condition that could compromise the patient's welfare Is at risk for infection or slow wound healing Has a chronic painful condition that might confound the assessment of pain associated with the sugery Has taken pain medication that could confound the analgesic responses the day of surgery Has been treated within 2 weeks of surgery with agents that could affect the analgesic response Has been treated with monoamine oxidase inhibitors (MAOIs) or MAOIs have been stopped fewer than 10 days prior to surgery Has been treated with corticosteroids or whose treatment with these has been stopped < 7 days prior surgery (inhaled corticosteroids are acceptable) Has participated in a clinical trial in the previous 30 days Has been hemodynamically unstable at any point in the previous 4 weeks or becomes hemodynamically unstable during surgery Required blood transfusion in the previous month, except as related to uterine bleeding caused by uterine fibroids. Has hemoglobin levels < 10 g/dL or < 8 g/dL for patients with an anemia secondary to heavy uterine bleeding caused by uterine fibroids. Has platelet count < 100,000/mm Unreliable or incapable of complying with the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Prior
Organizational Affiliation
Innocoll
Official's Role
Study Director
Facility Information:
Facility Name
Forsyth Medical Centre - OB Anesthesia
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27103
Country
United States

12. IPD Sharing Statement

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Efficacy and Safety of a Collagen Bupivacaine Implant in Women Following Abdominal Hysterectomy

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