Intraperitoneal Atomization of Levobupivacaine During Gynaecological Laparoscopic Procedures ; Impact on Pain, Opioid Use and Length of Recovery Room Stay (IPLA). (IPLA)

Study Description

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Brief Summary:

In this study, we will compare 3 treatments. The first group of patients will receive the standard treatment (paracetamol, diclofenac and an opioid if necessary) with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine) . The second group of patients will receive the standard of care, with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine) and additional injection of the local anesthetic ( 0.5% levobupivacaine, non -diluted) in the peritoneal cavity via a trocar both at the beginning and the end of the surgery . The third group of patients will receive the standard of care, with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine) and additional intraperitoneal atomization of the local anesthetic. We will use non-diluted 0.5% levobupivacaine delivered directly onto the target sites both at the beginning and the end of surgery. The drug will be delivered using OptiSpray® surgical spray device, an inexpensive delivery system that will direct a fine mist of drug directly to the areas of the peritoneal cavity that are theoretically the cause of post-op pain (diaphragms, peritoneal abdominal surface, surgical dissection site).

Our primary goal is to assess the efficacy of intraperitoneal atomization of levobupivacaine in reducing postoperative pain and of opioid requirements in patients undergoing gynecological laparoscopic procedures in one-day surgery.

Condition or disease	Intervention/treatment	Phase
Post-operative Pain After Laparoscopic One-day Surgery.	Drug: Standard Injection of Levobupivacaine in portal sites.; Drug: Additional injection of 0,5% levobupivacaine.; Drug: Intraperitoneal atomization of levobupivacaine.	Phase 4

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	60 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Intraperitoneal Atomization of Levobupivacaine During Gynaecological Laparoscopic Procedures ; Impact on Pain, Opioid Use and Length of Recovery Room Stay (IPLA).
Study Start Date :	June 2013
Estimated Primary Completion Date :	July 2015
Estimated Study Completion Date :	July 2015

Arms and Interventions

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Arm	Intervention/treatment
Active Comparator: Infiltration of portal sites with 0,5% levobupivacaine.; The first group of patients will receive the standard treatment (paracetamol, diclofenac and an opioid if necessary) with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine).	Drug: Standard Injection of Levobupivacaine in portal sites.; All port sites will be injected with 0.1ml/kg levobupivacaine at the end of surgery, after trocar removal.
Experimental: Additional injection of 0.5% levobupivacaine via a trocar; The second group of patients will receive the standard of care, with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine) and additional injection of the local anesthetic ( 0.5% levobupivacaine, non -diluted) in the peritoneal cavity via a trocar both at the beginning and the end of the surgery.	Drug: Standard Injection of Levobupivacaine in portal sites.; All port sites will be injected with 0.1ml/kg levobupivacaine at the end of surgery, after trocar removal. Drug: Additional injection of 0,5% levobupivacaine.; Immediately following insufflation 0.15ml/kg levobupivacaine will be injected in the peritoneal cavity via a trocar. At the end of the surgery, this process will be repeated with the same dose at 0.15ml/kg.
Experimental: Additional intraperitoneal atomization of levobupivacaine.; The third group of patients will receive the standard of care, with infiltration of the portal sites with the local anesthetic ( 0.5% levobupivacaine) and additional intraperitoneal atomization of the local anesthetic.	Drug: Standard Injection of Levobupivacaine in portal sites.; All port sites will be injected with 0.1ml/kg levobupivacaine at the end of surgery, after trocar removal. Drug: Intraperitoneal atomization of levobupivacaine.; Immediately following insufflation the Optispray® surgical spray device will be inserted into the abdomen and directed towards the diaphragms, dome of inflated abdomen, bowel peritoneum and surgical dissection site and the study drug will be delivered as an atomized spray in the following volumes: Each subdiaphragmatic area 0.05 ml/kg; Dome of abdomen then settling onto bowel 0.05 ml/kg; Surgical dissection site 0.05 ml/kg; At the end of the surgery - this process will be repeated with the same doses at 0.15 ml/kg.

Outcome Measures

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Primary Outcome Measures :

1. Post-operative pain intensity after laparoscopic gynaecological surgery in 1-day hospital setting. [ Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 1 day. ]
   Pain evaluation will be done using an 11-point numeric rating scale (0 = no pain, 10 = worst pain possible).
2. Post-operative shoulder pain after laparoscopic gynecological procedure in 1-day hospital setting. [ Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 1 day. ]
   Pain evaluation will be done using an 11-point numeric rating scale (0 = no pain, 10 = worst pain possible).

Secondary Outcome Measures :

1. Post-operative opioid analgesic requirements after laparoscopic gynaecological surgery. [ Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 1 day. ]
   Piritramide 0,05 mg/kg
2. Post-operative pain intensity after laparoscopic gynaecological surgery from hospital discharge until 24 hrs post-operatively. [ Time Frame: Patients will be followed until 24 hours post-operatively. ]
   Patients will be asked to evaluate their pain at 6 hrs, 12 hrs, 18 hrs and 24 hrs post-operatively using an 11-point numeric rating scale (0=no pain and 10= worse pain possible) and report it by telephone.
3. Post-operative shoulder pain after laparoscopic gynecological surgery from hospital discharge until 24 hrs post-operatively. [ Time Frame: Patients will be followed until 24 hours post-operatively. ]
   Patients will be asked to evaluate their pain at 6 hrs, 12 hrs, 18 hrs and 24 hrs post-operatively using an 11-point numeric rating scale (0=no pain and 10= worse pain possible) and report it by telephone.
4. Post-operative nausea and vomiting (PONV) in the first 24 hrs post-operatively, after laparoscopic gynecological surgery. [ Time Frame: Patients will be followed until 24 hours post-operatively. ]
   Nausea and vomiting will be evaluated every 15' during the first 2 hrs, every 30' until hospital discharge, using a PONV verbal descriptor scale 0 to 2 points : 0=no nausea, 1=any nausea, 2 =vomiting. After discharge, patients wil be asked to evaluate PONV at 6 hrs, 12 hrs, 18 hrs and 24 hrs post-operatively and report it by telephone.
5. Post-operative sedation until hospital discharge, after laparoscopic gynecological surgery. [ Time Frame: Patients will be followed up to 6 hrs post-operatively. ]
   Sedation will be evaluated at 0, 1, 2, 4, 6 hrs post-operatively, using the Ramsay sedation score (1= anxious and agitated, 2= cooperative, tranquil, oriented, 3=responds only to verbal commands, 4= asleep with brisk response to light stimulation, 5=asleep without response to light stimulation, 6=non-responsive).
6. Time until discharge from recovery room. [ Time Frame: Up until discharge from recovery room post-operatively, probably a few hours. ]
   Discharge criterion: aldrete ≥ 9/10.
7. Time until discharge from hospital. [ Time Frame: Patients will be followed until an estimated 24 hours post-operatively. ]
   Discharge criterion : modified aldrete ≥ 12/14.

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patients who are planned for gynaecological laparoscopic interventions on an ambulatory basis.

Exclusion Criteria:

• Less than 18 year old.
• Weight less than 50 kg and more than 80 kg.
• Pregnant.
• Prisoners;
• Allergic to topical anesthetics (Amides specifically).
• Allergic to Opioids as a class.
• Currently or within the last 30 days been prescribed an opiate medication.
• Chronic pain syndrome.

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Marc Coppens, MD		Marc.Coppens@ugent.be

Locations

Belgium
Ghent University Hospital	Recruiting
Ghent, Belgium, 9000
Contact: Marc Coppens, MD Marc.Coppens@ugent.be
Principal Investigator: Marc Coppens, MD

Sponsors and Collaborators

University Hospital, Ghent

Investigators

Principal Investigator:	Marc Coppens, mD	University Hospital, Ghent

More Information

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Additional Information:

Related Info 

Responsible Party:	University Hospital, Ghent
ClinicalTrials.gov Identifier:	NCT01886352 History of Changes
Other Study ID Numbers:	2013/089
First Posted:	June 25, 2013
Last Update Posted:	December 5, 2014
Last Verified:	December 2014

Keywords provided by University Hospital, Ghent:

laparoscopic; pain

Additional relevant MeSH terms:

Pain, Postoperative; Pain; Neurologic Manifestations; Nervous System Diseases; Postoperative Complications; Pathologic Processes; Signs and Symptoms; Analgesics, Opioid; Levobupivacaine	Bupivacaine; Narcotics; Central Nervous System Depressants; Physiological Effects of Drugs; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Anesthetics, Local; Anesthetics