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Trial of Extended Release Bupivacaine for Pain Relief After Surgery (PERSIST)

Primary Purpose

Post Operative Pain

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
SABER-Bupivacaine (Part 1)
SABER-Bupivacaine (Part 2)
Saline Placebo
Bupivacaine HCl
Sponsored by
Durect
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Post Operative Pain focused on measuring Post-operative pain, non-opioid analgesic, opioid reduction, laparoscopic cholecystectomy, laparoscopic surgery, bupivacaine, extended release, locally acting analgesic

Eligibility Criteria

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

Inclusion Criteria:

  • Patients scheduled for elective outpatient laparoscopic cholecystectomy using a conventional 4-port laparoscopic procedure.
  • Must be able and willing to provide written informed consent, complete trial-related procedures, and communicate with the trial staff.
  • Males and females 18 years of age or older.
  • ASA Class I, II, or III.
  • Patients of child-bearing potential must agree to use a medically acceptable method of contraception to prevent pregnancy for the duration of their participation in the trial.
  • Must be living close enough to the investigative site to attend the four scheduled follow-up clinic visits.

Exclusion Criteria:

  • Pregnant or nursing females.
  • Patients with absolute or relative contraindications to laparoscopic cholecystectomy.
  • Patients with prior midline abdominal surgery who are at risk for adhesions that may complicate laparoscopic cholecystectomy and/or accurate pain assessments.
  • Patients requiring emergency surgery or urgent surgery (fewer than 5 days between screening and surgery).
  • Patients with a pre-planned overnight stay or pre-planned hospital admission.
  • Patients scheduled for single incision, mini trocars, natural orifice transluminal endoscopic surgery (NOTES), robotic laparoscopic procedures, or any procedure (other than cholangiograms and minimal adhesiolysis) in addition to laparoscopic cholecystectomy.
  • Patients with known hypersensitivity to amide local anesthetics such as bupivacaine.
  • Patients with acute pain that is not due to cholecystitis.
  • Patients with a history of chronic pain unrelated to gallbladder disease.
  • Patients with ongoing depression or psychosis.
  • Patients undergoing long-term treatment with opioids or other analgesics, including acetaminophen, NSAIDs, anticonvulsants (gabapentin or pregabalin), and antidepressants (SSRIs, SNRIs, and tricyclics), but not including daily low-dose aspirin.
  • Patients who are being treated chronically with systemic corticosteroids or who will require peri-operative corticosteroids because of adrenal insufficiency (inhalational or topical corticosteroids are permitted).
  • Patients who may be unsuitable for opioid administration (such as sensitivity [e.g., history of severe nausea and vomiting] hypersensitivity, known history of abuse or addiction, or unwillingness to take prescribed rescue opioids).
  • Use of anticoagulants and antiplatelet drugs (with exception of low dose aspirin) in the 1 week prior to surgery.
  • Patients who are incapable of operating the electronic diary.
  • Patients participating in any other trial with an investigational drug or device concurrently or less than 30 days prior to surgery for this trial.
  • Patients who, in the Investigator's opinion, should not participate in the trial or may not be capable of following the trial procedures for any reason.

Sites / Locations

  • Durect Study Site 04
  • Durect Study Site 03
  • DURECT Study Site 24
  • Durect Study Site 15
  • Durect Study Site 02
  • Durect Study Site 18
  • Durect Study Site 22
  • Durect Study Site 12
  • Durect Study Site 21
  • Durect Study Site 17
  • Durect Study Site 16
  • Durect Study Site 20
  • Durect Study Site 05
  • Durect Study Site 13
  • Durect Study Site 09
  • Durect Study Site 11
  • Durect Study Site 07
  • Durect Study Site 14
  • Durect Study Site 08
  • DURECT Study Site 01
  • Durect Study Site 23

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Part 1

Part 2

Arm Description

SABER-Bupivacaine and Saline Placebo

SABER-Bupivacaine and Bupivacaine HCl

Outcomes

Primary Outcome Measures

Pain Intensity on Movement From 0-48 Hours Post-Treatment
A derived measure computed based on a patient-reported numerical pain rating scale assessing pain as a whole number from 0 (no pain) to 10 (worst pain imaginable) when the subject sits up from a supine position. This measure was evaluated by electronic diary at 13 planned time points from 0 to 48 hours post-treatment. The values reported are mean pain scores for each treatment group.

Secondary Outcome Measures

Pain Intensity Using the NPRS-11 With Movement
A derived measure computed based on a patient-reported numerical pain rating scale assessing pain as a whole number from 0 (no pain) to 10 (worst pain imaginable) when the subject sits up from a supine position. This measure was evaluated by electronic diary at 17 planned time points from 0 to 72 hours post-treatment. The values reported are mean pain scores for each treatment group.
Total IV Morphine-equivalent Dose of Rescue Opioids
IV morphine-equivalent dose
Composite Endpoint of Silverman's Integrated Analgesic (SIA) Assessment Score
Score of Integrated Analgesia (SIA) is a composite endpoint that integrates pain assessment scores with opioid use over various collections of timepoints by ranking the pain score and the opioid use separately across treatments. After the scores are computed the means are calculated across time points to provide a single overall treatment effect. The composite SIA score ranges from -200 to 200 with -200 being the best case and 200 the worst case.
Subjects Not Taking Rescue Medication From PACU Discharge to 72 Hours
Pooled SABER-Bupivacaine parts 1 + 2 vs. Bupivacaine HCl
Time to First Opioid Rescue Medication Use After Discharge From the PACU
Pooled SABER-Bupivacaine parts 1 + 2 vs. Bupivacaine HCl
Time to PACU Discharge Eligibility as Assessed by Modified Post-Anesthesia Discharge Scoring System (mPADSS)
mPADSS is a tool used to determine eligibility for discharge from the PACU after ambulatory surgery. It includes an assessment of parameters such as vital signs, activity level, nausea/vomiting, pain, and surgical bleeding. For this trial, evaluation of eligibility for PACU discharge by mPADSS has been slightly modified to provide a standardized means of assessing eligibility for PACU discharge across multiple investigative sites and also ensures that nonmedical complications, such as a missing ride home, do not interfere with evaluation of test drug effects.

Full Information

First Posted
October 9, 2015
Last Updated
June 21, 2021
Sponsor
Durect
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1. Study Identification

Unique Protocol Identification Number
NCT02574520
Brief Title
Trial of Extended Release Bupivacaine for Pain Relief After Surgery
Acronym
PERSIST
Official Title
A Placebo-controlled (Part 1) or Active-controlled (Part 2) Trial of SABER® -Bupivacaine for the Management of Postoperative Pain Following Laparoscopic Cholecystectomy (PERSIST)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2021
Overall Recruitment Status
Completed
Study Start Date
November 2015 (Actual)
Primary Completion Date
June 2017 (Actual)
Study Completion Date
August 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Durect

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
This is a research study of SABER® -Bupivacaine, an experimental medication designed to reduce pain for up to 3 days after surgery. Given once by the surgeon at the end of surgery, SABER® - Bupivacaine delivers a locally-acting pain reliever directly to the surgical wound. The purpose of this study is to measure how well it works in reducing pain after laparoscopic cholecystectomy (surgery to remove the gall bladder) and to investigate the safety of SABER®-Bupivacaine (its side effects).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Post Operative Pain
Keywords
Post-operative pain, non-opioid analgesic, opioid reduction, laparoscopic cholecystectomy, laparoscopic surgery, bupivacaine, extended release, locally acting analgesic

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
399 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Part 1
Arm Type
Placebo Comparator
Arm Description
SABER-Bupivacaine and Saline Placebo
Arm Title
Part 2
Arm Type
Active Comparator
Arm Description
SABER-Bupivacaine and Bupivacaine HCl
Intervention Type
Drug
Intervention Name(s)
SABER-Bupivacaine (Part 1)
Other Intervention Name(s)
POSIMIR® bupivacaine solution
Intervention Description
5 ml once at end of surgery
Intervention Type
Drug
Intervention Name(s)
SABER-Bupivacaine (Part 2)
Other Intervention Name(s)
POSIMIR® bupivacaine solution
Intervention Description
5 ml once at end of surgery
Intervention Type
Drug
Intervention Name(s)
Saline Placebo
Other Intervention Name(s)
placebo
Intervention Description
5 ml once at end of surgery
Intervention Type
Drug
Intervention Name(s)
Bupivacaine HCl
Intervention Description
0.5%, 15 ml, once at end of surgery
Primary Outcome Measure Information:
Title
Pain Intensity on Movement From 0-48 Hours Post-Treatment
Description
A derived measure computed based on a patient-reported numerical pain rating scale assessing pain as a whole number from 0 (no pain) to 10 (worst pain imaginable) when the subject sits up from a supine position. This measure was evaluated by electronic diary at 13 planned time points from 0 to 48 hours post-treatment. The values reported are mean pain scores for each treatment group.
Time Frame
Assessed from 0 to 48 hours post-dose, summary measure (see description) reported.
Secondary Outcome Measure Information:
Title
Pain Intensity Using the NPRS-11 With Movement
Description
A derived measure computed based on a patient-reported numerical pain rating scale assessing pain as a whole number from 0 (no pain) to 10 (worst pain imaginable) when the subject sits up from a supine position. This measure was evaluated by electronic diary at 17 planned time points from 0 to 72 hours post-treatment. The values reported are mean pain scores for each treatment group.
Time Frame
Assessed from 0 to 72 hours post-dose, summary measure (see description) reported.
Title
Total IV Morphine-equivalent Dose of Rescue Opioids
Description
IV morphine-equivalent dose
Time Frame
0-72 hrs. post dose (after surgery)
Title
Composite Endpoint of Silverman's Integrated Analgesic (SIA) Assessment Score
Description
Score of Integrated Analgesia (SIA) is a composite endpoint that integrates pain assessment scores with opioid use over various collections of timepoints by ranking the pain score and the opioid use separately across treatments. After the scores are computed the means are calculated across time points to provide a single overall treatment effect. The composite SIA score ranges from -200 to 200 with -200 being the best case and 200 the worst case.
Time Frame
0 to 72 hours
Title
Subjects Not Taking Rescue Medication From PACU Discharge to 72 Hours
Description
Pooled SABER-Bupivacaine parts 1 + 2 vs. Bupivacaine HCl
Time Frame
From PACU Discharge to 72 Hours post-treatment
Title
Time to First Opioid Rescue Medication Use After Discharge From the PACU
Description
Pooled SABER-Bupivacaine parts 1 + 2 vs. Bupivacaine HCl
Time Frame
From PACU Discharge to 72 Hours post-treatment
Title
Time to PACU Discharge Eligibility as Assessed by Modified Post-Anesthesia Discharge Scoring System (mPADSS)
Description
mPADSS is a tool used to determine eligibility for discharge from the PACU after ambulatory surgery. It includes an assessment of parameters such as vital signs, activity level, nausea/vomiting, pain, and surgical bleeding. For this trial, evaluation of eligibility for PACU discharge by mPADSS has been slightly modified to provide a standardized means of assessing eligibility for PACU discharge across multiple investigative sites and also ensures that nonmedical complications, such as a missing ride home, do not interfere with evaluation of test drug effects.
Time Frame
From admission to discharge from PACU (Approximately 0 to 12 hours)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients scheduled for elective outpatient laparoscopic cholecystectomy using a conventional 4-port laparoscopic procedure. Must be able and willing to provide written informed consent, complete trial-related procedures, and communicate with the trial staff. Males and females 18 years of age or older. ASA Class I, II, or III. Patients of child-bearing potential must agree to use a medically acceptable method of contraception to prevent pregnancy for the duration of their participation in the trial. Must be living close enough to the investigative site to attend the four scheduled follow-up clinic visits. Exclusion Criteria: Pregnant or nursing females. Patients with absolute or relative contraindications to laparoscopic cholecystectomy. Patients with prior midline abdominal surgery who are at risk for adhesions that may complicate laparoscopic cholecystectomy and/or accurate pain assessments. Patients requiring emergency surgery or urgent surgery (fewer than 5 days between screening and surgery). Patients with a pre-planned overnight stay or pre-planned hospital admission. Patients scheduled for single incision, mini trocars, natural orifice transluminal endoscopic surgery (NOTES), robotic laparoscopic procedures, or any procedure (other than cholangiograms and minimal adhesiolysis) in addition to laparoscopic cholecystectomy. Patients with known hypersensitivity to amide local anesthetics such as bupivacaine. Patients with acute pain that is not due to cholecystitis. Patients with a history of chronic pain unrelated to gallbladder disease. Patients with ongoing depression or psychosis. Patients undergoing long-term treatment with opioids or other analgesics, including acetaminophen, NSAIDs, anticonvulsants (gabapentin or pregabalin), and antidepressants (SSRIs, SNRIs, and tricyclics), but not including daily low-dose aspirin. Patients who are being treated chronically with systemic corticosteroids or who will require peri-operative corticosteroids because of adrenal insufficiency (inhalational or topical corticosteroids are permitted). Patients who may be unsuitable for opioid administration (such as sensitivity [e.g., history of severe nausea and vomiting] hypersensitivity, known history of abuse or addiction, or unwillingness to take prescribed rescue opioids). Use of anticoagulants and antiplatelet drugs (with exception of low dose aspirin) in the 1 week prior to surgery. Patients who are incapable of operating the electronic diary. Patients participating in any other trial with an investigational drug or device concurrently or less than 30 days prior to surgery for this trial. Patients who, in the Investigator's opinion, should not participate in the trial or may not be capable of following the trial procedures for any reason.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dave Ellis, MD
Organizational Affiliation
Durect
Official's Role
Study Director
Facility Information:
Facility Name
Durect Study Site 04
City
Florence
State/Province
Alabama
ZIP/Postal Code
35360
Country
United States
Facility Name
Durect Study Site 03
City
Sheffield
State/Province
Alabama
ZIP/Postal Code
35660
Country
United States
Facility Name
DURECT Study Site 24
City
Arcadia
State/Province
California
ZIP/Postal Code
91007
Country
United States
Facility Name
Durect Study Site 15
City
Fontana
State/Province
California
ZIP/Postal Code
92335
Country
United States
Facility Name
Durect Study Site 02
City
Laguna Hills
State/Province
California
ZIP/Postal Code
92653
Country
United States
Facility Name
Durect Study Site 18
City
Laguna Hills
State/Province
California
ZIP/Postal Code
92653
Country
United States
Facility Name
Durect Study Site 22
City
Pensacola
State/Province
Florida
ZIP/Postal Code
32503
Country
United States
Facility Name
Durect Study Site 12
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Durect Study Site 21
City
Royal Oak
State/Province
Michigan
ZIP/Postal Code
48073
Country
United States
Facility Name
Durect Study Site 17
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39202
Country
United States
Facility Name
Durect Study Site 16
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89104
Country
United States
Facility Name
Durect Study Site 20
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89109
Country
United States
Facility Name
Durect Study Site 05
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States
Facility Name
Durect Study Site 13
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Durect Study Site 09
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Durect Study Site 11
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44111
Country
United States
Facility Name
Durect Study Site 07
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Durect Study Site 14
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Durect Study Site 08
City
Houston
State/Province
Texas
ZIP/Postal Code
77004
Country
United States
Facility Name
DURECT Study Site 01
City
Houston
State/Province
Texas
ZIP/Postal Code
77043
Country
United States
Facility Name
Durect Study Site 23
City
Plano
State/Province
Texas
ZIP/Postal Code
75093
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Trial of Extended Release Bupivacaine for Pain Relief After Surgery

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