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Efficacy, Safety and Pharmacokinetic Profile of a Collagen Bupivacaine Implant in Men After Open Mesh Herniorrhaphy

Primary Purpose

Postoperative Pain, Inguinal Hernia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bupivacaine Collagen Sponge
placebo collagen sponge
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 Herniorrhaphy, Inguinal Hernia Repair, Postoperative pain

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Has body mass index (BMI) > 19 and < 40 kg/m2.
  • Has a planned unilateral inguinal herniorrhaphy (open mesh, tension free technique) to be performed according to standard surgical technique under general anesthesia.
  • Has a risk classification of I, II or III according to the ASA.
  • Is free of other physical or mental conditions that, in the opinion of the Investigator, may confound the quantification of postoperative pain after herniorrhaphy.
  • Has the ability and willingness to comply with the study procedures and the use of the pain scales.
  • Is willing to use only permitted medications and anesthetics throughout the study.
  • Is willing to use opioid rescue analgesia for moderate to severe incisional pain only.
  • Must voluntarily sign and date an informed consent form (ICF) that is approved by an Institutional Review Board (IRB) before the conduct of any study specific procedures.
  • Must be able to fluently speak and understand English and be able to provide meaningful written informed consent for the study.

Exclusion Criteria:

  • Has a known hypersensitivity to amide local anesthetics, opioids, bovine products or inactive ingredients of the test article.
  • Is scheduled for bilateral inguinal herniorrhaphy.
  • Has undergone a prior herniorrhaphy on the side that is currently scheduled for repair.
  • Has cardiac arrhythmias or atrioventricular (AV) conduction disorders.
  • Concomitantly uses antiarrhythmics (eg, amiodarone), propranolol or strong/moderate cytochrome P450 (CYP) 3A4 inhibitors or inducers (eg, macrolide antibiotics and grapefruit juice).
  • Has used long acting analgesics within 24 hours of surgery. Short acting analgesics such as acetaminophen may be used on the day of surgery
  • Has used aspirin or aspirin containing products within 7 days of surgery. Aspirin at a dose of ≤ 325 mg is allowed for cardiovascular prophylaxis if the patient has been on a stable dose regimen for ≥ 30 days before Screening.
  • Has undergone major surgery within 3 months of the scheduled herniorrhaphy.
  • Has known or suspected history of alcohol or drug abuse or misuse within 3 years of Screening or evidence of tolerance or physical dependency on opioid analgesics or sedative-hypnotic medications.
  • Has used opioids or tramadol on an extended daily basis (> 7 days) before surgery. Patients who, in the Investigator's opinion, are developing opioid tolerance are to be excluded.
  • Has impaired liver function, aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/bilirubin ≥ 3.0 times the upper limit of normal (ULN), active hepatic disease, evidence of clinically significant liver disease or another condition (eg, alcoholism, cirrhosis or hepatitis) that may suggest the potential for an increased susceptibility to hepatic toxicity with exposure to test article.
  • Has any clinically significant unstable cardiac, neurological, immunological, renal or hematological disease or any other condition that, in the opinion of the Investigator, could compromise the patient's welfare, ability to communicate with the study staff or otherwise contraindicate study participation.
  • Is judged by the Investigator to be at risk for infection or slow wound healing.
  • Has a chronic painful condition that might confound the assessment of pain associated with the herniorrhaphy.
  • Routinely uses pain medication that, in the opinion of the Investigator, could confound the pain assessments during the study.
  • Has been treated with agents that could affect the analgesic response (such as central alpha agents, neuroleptic agents and other antipsychotic agents) within 2 weeks of surgery.
  • Has been treated with monoamine oxidase inhibitors (MAOIs) within 10 days of surgery.
  • Has been treated with systemic corticosteroids within 7 days of surgery (inhaled and topical corticosteroids are allowed).
  • Has participated in a clinical trial within 30 days of surgery.

Sites / Locations

  • Advanced Clinical Research Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

1

2

Arm Description

Two, 5x5cm bupivacaine collagen sponges implanted during surgery

Placebo collagen sponge implanted during surgery

Outcomes

Primary Outcome Measures

Total Use of Opioid Rescue Analgesia Over 0 to 24 Hours
Total Use of Opioid Rescue Analgesia (mg) Over 0 to 24 Hour - number count - higher score means worse outcome

Secondary Outcome Measures

Total Use of Opioid Rescue Analgesia Over 0 to 48 Hours
Number count. Higher score means worse outcome
Total Use of Opioid Rescue Analgesia Over 0 to 72 Hours
Number count - higher score means worse outcome
Summed Pain Intensity VAS Scores (VAS at Rest and After Cough)
Summed pain intensity (SPI) (VAS at rest and after cough): - For the VAS assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a horizontal 100-mm VAS scale labeled as follows: No Pain (0 mm) as the left anchor and Worst Pain Imaginable (100 mm) as the right anchor. Each timepoint consist of two measurements (Resting & Coughing) - The lower the score the better outcome for the patient. The highest total score (worst possible score) for the 10 timepoints would be 2000.
Patient's Global Evaluation of the Study Treatment on a 5 Point Likert Scale
For the 5-point categorical scale global evaluation of study treatment, the patient was instructed to score his global evaluation of the pain control provided by the study treatment where: 0 = poor, 1 = fair, 2 = good, 3 = very good and 4 = excellent
VAS Pain Intensity Scores Over Time
For the VAS assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a horizontal 100-mm VAS scale labeled as follows: No Pain (0 mm) as the left anchor and Worst Pain Imaginable (100 mm) as the right anchor.
Categorical Pain Intensity Scores Over Time - AT REST
For the 4-point categorical scale assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."
Categorical Pain Relief Scores Over Time - AT REST
For the 5-point categorical scale assessment of pain relief, the patient was instructed to score his pain relief using a numerical scale where: 0 = no relief, 1 = a little relief, 2 = some relief, 3 = a lot of relief and 4 = complete relief.
Categorical Pain Intensity Scores Over Time (After Cough)
For the 4-point categorical scale assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe." Higher Score means a worse outcome
Categorical Pain Relief Scores Over Time (After Cough)
For the 5-point categorical scale assessment of pain relief, the patient was instructed to score his pain relief using a numerical scale where: 0 = no relief, 1 = a little relief, 2 = some relief, 3 = a lot of relief and 4 = complete relief.

Full Information

First Posted
February 20, 2008
Last Updated
January 6, 2021
Sponsor
Innocoll
Collaborators
Premier Research Group plc
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1. Study Identification

Unique Protocol Identification Number
NCT00626886
Brief Title
Efficacy, Safety and Pharmacokinetic Profile of a Collagen Bupivacaine Implant in Men After Open Mesh Herniorrhaphy
Official Title
A Phase II, Randomized, Single Dose, Double-blind, Placebo-controlled Study to Investigate the Efficacy, Safety and Pharmacokinetic Profile of the CollaRx® Bupivacaine Implant in Men After Open Mesh Herniorrhaphy
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Completed
Study Start Date
March 11, 2008 (Actual)
Primary Completion Date
January 29, 2009 (Actual)
Study Completion Date
January 29, 2009 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

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 herniorrhaphy.
Detailed Description
Inguinal herniorrhaphy is a common surgery; and common surgical methods used include laparoscopic and open placement of synthetic mesh. The use of synthetic mesh can greatly reduce the risk of hernia recurrence regardless of the method used for its placement. Managing postoperative pain and preventing morbidity after open mesh herniorrhaphy remain considerable medical challenges. 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 either the CollaRx Bupivacaine implant or a plain collagen sponge.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Postoperative Pain, Inguinal Hernia
Keywords
Herniorrhaphy, Inguinal Hernia Repair, Postoperative pain

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Two, 5x5cm bupivacaine collagen sponges implanted during surgery
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
Placebo collagen sponge implanted during surgery
Intervention Type
Drug
Intervention Name(s)
Bupivacaine Collagen Sponge
Other Intervention Name(s)
CollaRx Bupivacaine Implant
Intervention Description
collagen; Bupivacaine hydrocholoride
Intervention Type
Drug
Intervention Name(s)
placebo collagen sponge
Other Intervention Name(s)
Placebo
Intervention Description
collagen
Primary Outcome Measure Information:
Title
Total Use of Opioid Rescue Analgesia Over 0 to 24 Hours
Description
Total Use of Opioid Rescue Analgesia (mg) Over 0 to 24 Hour - number count - higher score means worse outcome
Time Frame
0 to 24 hours postoperatively
Secondary Outcome Measure Information:
Title
Total Use of Opioid Rescue Analgesia Over 0 to 48 Hours
Description
Number count. Higher score means worse outcome
Time Frame
0 to 48 hours postoperatively
Title
Total Use of Opioid Rescue Analgesia Over 0 to 72 Hours
Description
Number count - higher score means worse outcome
Time Frame
0 to 72 hours postoperatively
Title
Summed Pain Intensity VAS Scores (VAS at Rest and After Cough)
Description
Summed pain intensity (SPI) (VAS at rest and after cough): - For the VAS assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a horizontal 100-mm VAS scale labeled as follows: No Pain (0 mm) as the left anchor and Worst Pain Imaginable (100 mm) as the right anchor. Each timepoint consist of two measurements (Resting & Coughing) - The lower the score the better outcome for the patient. The highest total score (worst possible score) for the 10 timepoints would be 2000.
Time Frame
1, 1.5, 2, 3, 4, 5, 6, 24, 48 and 72 hours after Time 0
Title
Patient's Global Evaluation of the Study Treatment on a 5 Point Likert Scale
Description
For the 5-point categorical scale global evaluation of study treatment, the patient was instructed to score his global evaluation of the pain control provided by the study treatment where: 0 = poor, 1 = fair, 2 = good, 3 = very good and 4 = excellent
Time Frame
At 72 hours after time 0
Title
VAS Pain Intensity Scores Over Time
Description
For the VAS assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a horizontal 100-mm VAS scale labeled as follows: No Pain (0 mm) as the left anchor and Worst Pain Imaginable (100 mm) as the right anchor.
Time Frame
At 1, 1.5, 2,3,4,5,6,24,48,72 Hours
Title
Categorical Pain Intensity Scores Over Time - AT REST
Description
For the 4-point categorical scale assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe."
Time Frame
At 0.5, 1, 1.5, 2, 3, 4, 5, 6, 24, 48 and 72 hours
Title
Categorical Pain Relief Scores Over Time - AT REST
Description
For the 5-point categorical scale assessment of pain relief, the patient was instructed to score his pain relief using a numerical scale where: 0 = no relief, 1 = a little relief, 2 = some relief, 3 = a lot of relief and 4 = complete relief.
Time Frame
At 0.5, 1, 1.5, 2, 3, 4, 5, 6, 24, 48 and 72 hours
Title
Categorical Pain Intensity Scores Over Time (After Cough)
Description
For the 4-point categorical scale assessment, patients measured their pain intensity at rest and after aggravated movement (cough) using a numerical scale where: 0 = "none," 1 = "mild," 2 = "moderate" and 3 = "severe." Higher Score means a worse outcome
Time Frame
At 0.5, 1, 1.5, 2, 3, 4, 5, 6, 24, 48 and 72 hours
Title
Categorical Pain Relief Scores Over Time (After Cough)
Description
For the 5-point categorical scale assessment of pain relief, the patient was instructed to score his pain relief using a numerical scale where: 0 = no relief, 1 = a little relief, 2 = some relief, 3 = a lot of relief and 4 = complete relief.
Time Frame
At 0.5, 1, 1.5, 2, 3, 4, 5, 6, 24, 48 and 72 hours

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Has body mass index (BMI) > 19 and < 40 kg/m2. Has a planned unilateral inguinal herniorrhaphy (open mesh, tension free technique) to be performed according to standard surgical technique under general anesthesia. Has a risk classification of I, II or III according to the ASA. Is free of other physical or mental conditions that, in the opinion of the Investigator, may confound the quantification of postoperative pain after herniorrhaphy. Has the ability and willingness to comply with the study procedures and the use of the pain scales. Is willing to use only permitted medications and anesthetics throughout the study. Is willing to use opioid rescue analgesia for moderate to severe incisional pain only. Must voluntarily sign and date an informed consent form (ICF) that is approved by an Institutional Review Board (IRB) before the conduct of any study specific procedures. Must be able to fluently speak and understand English and be able to provide meaningful written informed consent for the study. Exclusion Criteria: Has a known hypersensitivity to amide local anesthetics, opioids, bovine products or inactive ingredients of the test article. Is scheduled for bilateral inguinal herniorrhaphy. Has undergone a prior herniorrhaphy on the side that is currently scheduled for repair. Has cardiac arrhythmias or atrioventricular (AV) conduction disorders. Concomitantly uses antiarrhythmics (eg, amiodarone), propranolol or strong/moderate cytochrome P450 (CYP) 3A4 inhibitors or inducers (eg, macrolide antibiotics and grapefruit juice). Has used long acting analgesics within 24 hours of surgery. Short acting analgesics such as acetaminophen may be used on the day of surgery Has used aspirin or aspirin containing products within 7 days of surgery. Aspirin at a dose of ≤ 325 mg is allowed for cardiovascular prophylaxis if the patient has been on a stable dose regimen for ≥ 30 days before Screening. Has undergone major surgery within 3 months of the scheduled herniorrhaphy. Has known or suspected history of alcohol or drug abuse or misuse within 3 years of Screening or evidence of tolerance or physical dependency on opioid analgesics or sedative-hypnotic medications. Has used opioids or tramadol on an extended daily basis (> 7 days) before surgery. Patients who, in the Investigator's opinion, are developing opioid tolerance are to be excluded. Has impaired liver function, aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/bilirubin ≥ 3.0 times the upper limit of normal (ULN), active hepatic disease, evidence of clinically significant liver disease or another condition (eg, alcoholism, cirrhosis or hepatitis) that may suggest the potential for an increased susceptibility to hepatic toxicity with exposure to test article. Has any clinically significant unstable cardiac, neurological, immunological, renal or hematological disease or any other condition that, in the opinion of the Investigator, could compromise the patient's welfare, ability to communicate with the study staff or otherwise contraindicate study participation. Is judged by the Investigator to be at risk for infection or slow wound healing. Has a chronic painful condition that might confound the assessment of pain associated with the herniorrhaphy. Routinely uses pain medication that, in the opinion of the Investigator, could confound the pain assessments during the study. Has been treated with agents that could affect the analgesic response (such as central alpha agents, neuroleptic agents and other antipsychotic agents) within 2 weeks of surgery. Has been treated with monoamine oxidase inhibitors (MAOIs) within 10 days of surgery. Has been treated with systemic corticosteroids within 7 days of surgery (inhaled and topical corticosteroids are allowed). Has participated in a clinical trial within 30 days of surgery.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Prior
Organizational Affiliation
Innocoll
Official's Role
Study Director
Facility Information:
Facility Name
Advanced Clinical Research Institute
City
Anaheim
State/Province
California
ZIP/Postal Code
92801
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
22792007
Citation
Cusack SL, Jaros M, Kuss M, Minkowitz HS, Winkle P, Hemsen L. Clinical evaluation of XaraColl((R)), a bupivacaine-collagen implant, for postoperative analgesia in two multicenter, randomized, double-blind, placebo-controlled pilot studies. J Pain Res. 2012;5:217-25. doi: 10.2147/JPR.S33453. Epub 2012 Jun 27.
Results Reference
result
Links:
URL
http://www.dovepress.com/articles.php?article_id=10236
Description
Clinical evaluation of a Bupivacaine-Collagen Implant (XaraColl®) for postoperative analgesia from two multicenter, randomized, double-blind, placebo-controlled pilot studies

Learn more about this trial

Efficacy, Safety and Pharmacokinetic Profile of a Collagen Bupivacaine Implant in Men After Open Mesh Herniorrhaphy

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