Postoperative Pain
Conditions
Keywords
Anesthetics, Anesthetic Effects, Mid-urethral sling
Brief summary
Postoperative pain, the quality of their recovery and the opioid consumption following a midurethral sling placement are being compared between 2 groups. One group will have the hydro-dissection performed with a diluted liposomal bupivacaine solution. The other group will have the hydro-dissection performed with a diluted bupivacaine HCL and Lidocaine solution.
Detailed description
This is a prospective, comparative, randomized study. Women with pure stress urinary incontinence or mixed urinary incontinence with a predominant stress component who had chosen to proceed with a midurethral sling will be randomized to two groups. The study group will have the hydro-dissection performed with a diluted liposomal bupivacaine solution. The comparison group would have the hydro-dissection performed with a diluted bupivacaine HCL and Lidocaine solution. The postoperative pain will be compared between groups using a visual analog scale. The quality of recovery will be compared between the groups using the quality of recovery short form. Postoperative opioid consumption will be compared between the two groups.
Interventions
DRUGLiposomal Bupivacaine
20 mL of Liposomal Bupivacaine (EXPAREL) will be diluted in 80 mL of injectable saline used for hydro-dissection of the vesicovaginal space and along the track of the sling trocars
DRUGBupivacaine Hydrochloride and Lidocaine
Bupivacaine Hydrochloride (HCL) and Lidocaine. Fifty mL of 0.05% Marcaine and 30 mL of Lidocaine will be diluted in 100 mL of injectable saline used for hydro-dissection of the vesicovaginal space and along the track of the sling trocars during the placement of a suburethral sling.
PROCEDURESuburethral Sling
A retropubic, transobturator or mini-sling will be placed in the usual fashion followed by diagnostic cystoscopy.
Sponsors
Atlantic Health System
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
19 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* ASA physical status I-III * Age \>18 years * Not Pregnant * Able to give informed consent * Electively chose surgical management of SUI with a suburethral sling
Exclusion criteria
* Pregnant or nursing * Allergy to amide anesthetics * History of drug or alcohol abuse * Severe cardiovascular, hepatic, renal disease or neurological impairment, * Long-acting opioid within 3 days or any opioid use within 24 hours before surgery * Patients taking monoamineoxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types * Contraindication to: Acetaminophen, Non-steroidal anti-inflammatory drugs (NSAID), Hydrocodone, Oxycodone, Hydromorphone AND Morphine, * Administration of an investigational drug within 30 days before this study * Chronic pain syndromes * Daily NSAID or opioid use * Patients undergoing concomitant procedures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Day 1 Pain | Patient will record her average pain on postop day 1. She will return this result at her postop visit 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | Average pain rating experienced on postoperative day one using the visual analog scale (VAS) on scale of 0 to 10 cm. This will be recorded by the patient prior to going to bed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Upon Discharge | The PACU nurse will record the patient's pain level upon discharge to home. These results will be examined and compared at the completion of the study. | Visual analog scale (VAS) on scale of 0 to 10 cm will be used to evaluate the pain score experienced upon discharge from the hospital. |
| Postoperative Pain Four Hours After Discharge | Record the average pain 4 hours after discharge to home. She will return this result at her postop visit 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | Visual analog scale (VAS) on scale of 0 to 10 cm will be used to evaluate the pain score experienced. This will be recorded 4 hours after being discharged from the hospital. |
| Night of Surgery Postoperative Pain | Pt will record her average pain on the night of surgery. She will return this result at her postop visit which is approximately 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | Visual analog scale (VAS) on scale of 0 to 10 cm will be used to evaluate the pain score experienced that day and recorded prior to going to bed on the night of surgery. |
| Second Stage PACU Postoperative Pain | The PACU nurse will record the patient's pain level upon admission to second stage PACU. These results will be examined and compared at the completion of the study. | Visual analog scale (VAS) on scale of 0 to 10 cm will be used to evaluate the pain score experienced upon admission to second stage PACU. |
| Preoperative Quality of Recovery | The patient will complete the questionnaire prior to surgery. This will be collected prior to surgery. These results will be examined and compared at the completion of the study. | Baseline Quality of Life and Recovery as measured by the ambulatory QoR15 preoperatively on the day of surgery. |
| Postoperative Days 1, 7 and 14 Quality of Recovery | The patient will complete the questionnaire on postop days 1, 7 & 14. She will return these results at her postop visit 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | Quality of Life and Recovery as measured by the ambulatory QoR15 on postoperative days 1, 7 and 14. |
| Postoperative Narcotic Consumption | The patient will record narcotic consumption each day from the day of surgery to postop day 7. She will return this result at her postop visit 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | The total amount of narcotic taken the night of surgery and each day thereafter through postoperative day seven will be recorded each night prior to going to bed. |
| Postoperative Days 2 through 7 Pain | Pt will record her average pain from postop days 2-7. She will return this result at her postop visit 4-6 weeks after her surgery. These results will be examined and compared at the completion of the study. | Visual analog scale (VAS) on scale of 0 to 10 cm will be used to evaluate the pain score experienced that day and recorded prior to going to bed on postop days 2-7. |
Countries
United States
Outcome results
None listed