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Safety, Efficacy, and Pharmacokinetics of SKY0402 Administered as a Nerve Block in Subjects Undergoing Bunionectomy

Primary Purpose

Postoperative Pain

Status
Completed
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
SKY0402
Bupivacaine HCl
Sponsored by
Pacira Pharmaceuticals, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Postoperative Pain focused on measuring Postoperative Pain, Bunionectomy, Analgesia

Eligibility Criteria

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

Inclusion Criteria:

Subjects were eligible for enrollment if they met the following criteria:

  1. Males and females ≥18 years of age at the Screening Visit. NOTE: Eligible females were postmenopausal or surgically sterile, or, if of child bearing potential, were not pregnant or nursing, and they agreed to not become pregnant during the study by using acceptable means of contraception for at least 1 month before and 1 month after dosing, including any of the following: hormonal contraceptives (oral, injectable, implantable), effective barrier methods (e.g., condoms with spermicide), intrauterine device (IUD), lifestyle with a personal choice of abstinence, non-heterosexual lifestyle, or in a strictly monogamous relationship with a partner who has had a vasectomy.
  2. Scheduled to undergo a primary unilateral first metatarsal bunionectomy repair under general anesthesia, with or without internal fixation.

    NOTE: For the purpose of this protocol, all surgical procedures involving osteotomy of the first metatarsal (significant bone resection, excision, surgical fracture, etc.) or fusion of the first metatarsal phalangeal joint were considered qualified procedures, whether or not performed specifically to repair a bunion (hallus valgus deformity). Surgical techniques accompanied by minimal bone excision (e.g. cheilectomy) or procedures limited to soft tissue repair were not eligible for this study.

  3. American Society of Anesthesiology (ASA) Physical Class 1 or 2.
  4. Able and willing to comply with all study visits and procedures.
  5. Capable of speaking and understanding the local language sufficiently to provide responses to pain assessment scales.
  6. Willing and capable of providing written informed consent.

Exclusion Criteria:

Subjects were excluded from the study if they met any of the following criteria:

  1. Clinically significant electrocardiogram (ECG) abnormalities at Screening or on Day 1 (before dosing).
  2. Albumin and/or alpha 1 acid glycoprotein (AAG) below normal levels.
  3. Current or historical evidence of any clinically significant disease or condition that, in the opinion of the Investigator, might have increased the risk of surgery or complicated the subject's postoperative course.
  4. Opioid medication usage during the 7 day period preceding the administration of study drug.
  5. Current medical conditions that could have required treatment with analgesic medications in the postoperative period for pain that was not surgically related (e.g., rheumatoid arthritis).
  6. Body mass index >30 kg/m^2.
  7. Body weight less than 60 kilograms.
  8. History of hypersensitivity or idiosyncratic reaction to amide type local anesthetic agents.
  9. History of hypersensitivity, idiosyncratic reactions, and other contraindications to the pain control agents (opioid or non-opioid) anticipated to be used postoperatively. These contraindications may have included the following: angioedema and bronchospastic reactivity to non-steroidal anti-inflammatory drug (NSAID), peptic ulcer (active within the last 3 months), or hepatic or renal insufficiency.
  10. Coagulation disorders or ongoing anticoagulation treatment.
  11. Administration of an investigational drug within 30 days or 5 half lives (of elimination), whichever was longer, prior to study drug administration.
  12. Suspected or known history of substance abuse and/or alcoholism.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Active Comparator

    Arm Label

    SKY0402

    Bupivacaine HCl

    Arm Description

    Low-dose (175 mg), low-mid dose( 225 mg), and mid-dose (350 mg)

    Marcaine with epinephrine 1:200,000 is the reference-listed drug for bupivacaine and contains the same active, local anesthetic as SKY0402

    Outcomes

    Primary Outcome Measures

    Time to First Use of Supplemental Pain Medication Postoperatively for Surgical Pain
    The primary efficacy endpoint was the time to first use of supplemental pain medication (opioid or non-opioid) postoperatively for surgical pain.

    Secondary Outcome Measures

    Number of Patients With Adverse Events
    All adverse events were to be recorded from the time of dosing through Day 8. Serious adverse events (SAEs) were to be recorded through Day 30.

    Full Information

    First Posted
    September 19, 2010
    Last Updated
    January 4, 2021
    Sponsor
    Pacira Pharmaceuticals, Inc
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01206595
    Brief Title
    Safety, Efficacy, and Pharmacokinetics of SKY0402 Administered as a Nerve Block in Subjects Undergoing Bunionectomy
    Official Title
    A Phase 2, Multicenter, Randomized, Double Blind, Dose Escalating/ De-Escalating Study to Evaluate the Safety, Efficacy, and Pharmacokinetics of Sustained Release Encapsulated Bupivacaine (SKY0402) Administered as a Nerve Block in the Management of Postoperative Pain in Subjects Undergoing Bunionectomy
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2021
    Overall Recruitment Status
    Completed
    Study Start Date
    March 2005 (undefined)
    Primary Completion Date
    March 2006 (Actual)
    Study Completion Date
    December 2006 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Pacira Pharmaceuticals, Inc

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The primary objective of this study was to determine the appropriate dose of SKY0402 administered as a nerve block for the management of postoperative pain following bunionectomy.
    Detailed Description
    This Phase 2, multicenter, randomized, double blind, dose escalating/de-escalating study evaluated the safety, efficacy, and pharmacokinetics of a single dose of SKY0402 compared to a single 125 mg dose of bupivacaine HCl for the treatment of postoperative pain in subjects undergoing bunionectomy. Up to 88 subjects were to be randomized in five consecutive cohorts. The dose of bupivacaine HCl (125 mg) was to remain constant for all cohorts. After completion of Cohort 1, the decision to increase or decrease the dose of SKY0402 was made by a Cohort Data Review Committee following a review of pharmacokinetic, safety, and selected efficacy data from the previous cohort. Study drug was to be administered as an ankle block, with or without a tourniquet, between 1 hour before the induction of general anesthesia and 20 minutes before the end of general anesthesia. The ankle block procedure consisted of five injections via three skin entries targeting the following nerves: posterior tibial, sural, deep peroneal, superficial peroneal, and saphenous. The use of intravenous fentanyl during general anesthesia was permitted, but was not to exceed 250 micrograms. The intraoperative use of morphine was prohibited. Postoperatively, subjects had access to both opioid and non-opioid supplemental pain medication under general guidelines. Blood samples for the determination of plasma bupivacaine concentrations were obtained at Baseline and at specified time points through 96 hours.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Postoperative Pain
    Keywords
    Postoperative Pain, Bunionectomy, Analgesia

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantInvestigator
    Allocation
    Randomized
    Enrollment
    58 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    SKY0402
    Arm Type
    Active Comparator
    Arm Description
    Low-dose (175 mg), low-mid dose( 225 mg), and mid-dose (350 mg)
    Arm Title
    Bupivacaine HCl
    Arm Type
    Active Comparator
    Arm Description
    Marcaine with epinephrine 1:200,000 is the reference-listed drug for bupivacaine and contains the same active, local anesthetic as SKY0402
    Intervention Type
    Drug
    Intervention Name(s)
    SKY0402
    Intervention Description
    Single dose of SKY0402 administered as a nerve block
    Intervention Type
    Drug
    Intervention Name(s)
    Bupivacaine HCl
    Intervention Description
    Single dose of 125 mg administered as a nerve block
    Primary Outcome Measure Information:
    Title
    Time to First Use of Supplemental Pain Medication Postoperatively for Surgical Pain
    Description
    The primary efficacy endpoint was the time to first use of supplemental pain medication (opioid or non-opioid) postoperatively for surgical pain.
    Time Frame
    Through 96 hours postdose
    Secondary Outcome Measure Information:
    Title
    Number of Patients With Adverse Events
    Description
    All adverse events were to be recorded from the time of dosing through Day 8. Serious adverse events (SAEs) were to be recorded through Day 30.
    Time Frame
    Through 30 days postdose

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Subjects were eligible for enrollment if they met the following criteria: Males and females ≥18 years of age at the Screening Visit. NOTE: Eligible females were postmenopausal or surgically sterile, or, if of child bearing potential, were not pregnant or nursing, and they agreed to not become pregnant during the study by using acceptable means of contraception for at least 1 month before and 1 month after dosing, including any of the following: hormonal contraceptives (oral, injectable, implantable), effective barrier methods (e.g., condoms with spermicide), intrauterine device (IUD), lifestyle with a personal choice of abstinence, non-heterosexual lifestyle, or in a strictly monogamous relationship with a partner who has had a vasectomy. Scheduled to undergo a primary unilateral first metatarsal bunionectomy repair under general anesthesia, with or without internal fixation. NOTE: For the purpose of this protocol, all surgical procedures involving osteotomy of the first metatarsal (significant bone resection, excision, surgical fracture, etc.) or fusion of the first metatarsal phalangeal joint were considered qualified procedures, whether or not performed specifically to repair a bunion (hallus valgus deformity). Surgical techniques accompanied by minimal bone excision (e.g. cheilectomy) or procedures limited to soft tissue repair were not eligible for this study. American Society of Anesthesiology (ASA) Physical Class 1 or 2. Able and willing to comply with all study visits and procedures. Capable of speaking and understanding the local language sufficiently to provide responses to pain assessment scales. Willing and capable of providing written informed consent. Exclusion Criteria: Subjects were excluded from the study if they met any of the following criteria: Clinically significant electrocardiogram (ECG) abnormalities at Screening or on Day 1 (before dosing). Albumin and/or alpha 1 acid glycoprotein (AAG) below normal levels. Current or historical evidence of any clinically significant disease or condition that, in the opinion of the Investigator, might have increased the risk of surgery or complicated the subject's postoperative course. Opioid medication usage during the 7 day period preceding the administration of study drug. Current medical conditions that could have required treatment with analgesic medications in the postoperative period for pain that was not surgically related (e.g., rheumatoid arthritis). Body mass index >30 kg/m^2. Body weight less than 60 kilograms. History of hypersensitivity or idiosyncratic reaction to amide type local anesthetic agents. History of hypersensitivity, idiosyncratic reactions, and other contraindications to the pain control agents (opioid or non-opioid) anticipated to be used postoperatively. These contraindications may have included the following: angioedema and bronchospastic reactivity to non-steroidal anti-inflammatory drug (NSAID), peptic ulcer (active within the last 3 months), or hepatic or renal insufficiency. Coagulation disorders or ongoing anticoagulation treatment. Administration of an investigational drug within 30 days or 5 half lives (of elimination), whichever was longer, prior to study drug administration. Suspected or known history of substance abuse and/or alcoholism.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Kay Warnott, RN, ACNP
    Organizational Affiliation
    Parica Pharmaceuticals, Inc.
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Learn more about this trial

    Safety, Efficacy, and Pharmacokinetics of SKY0402 Administered as a Nerve Block in Subjects Undergoing Bunionectomy

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