- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03871478
Comparing the Efficacy of Local Anesthetics in Mohs Surgery
Mohs surgery is a very effective option in removing non-melanoma skin cancers, as the tissue being removed is analyzed the same day. If there are remnants of cancer cells in the tissue removed, the Mohs surgeon will go back and remove further tissue and repair the surgical wound all within the same day.
Unfortunately, postoperative pain is quite prevalent among patients requiring Mohs procedures, as up to 52% require an additional oral pain medication. Lidocaine is the most commonly used anesthetic used in Mohs given its rapid onset of action. However, the duration of lidocaine's effect is much shorter than bupivacaine, which may translate into increased postoperative pain.
To date, there are no specific studies comparing bupivacaine alone, lidocaine alone or both in conjunction in Mohs procedures.
The investigators predict bupivacaine alone and bupivacaine used in conjunction with lidocaine are more effective in managing pain during Mohs surgery than lidocaine alone.
To test our hypothesis, the investigators plan to have 105 patients receive either lidocaine alone, bupivacaine alone, or lidocaine and bupivacaine in conjunction during their Mohs procedure. Pain will be evaluated at various time points throughout the surgery.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Mohs surgery is a very effective option in removing non-melanoma skin cancers, as the tissue being removed is analyzed the same day. If there are remnants of cancer cells in the tissue removed, the Mohs surgeon will go back and remove further tissue and repair the surgical One option for treating non-melanoma skin cancer is Mohs Surgery, also known as Mohs Micrographic Surgery or Mohs Procedure.
Mohs surgery is a full-day procedure where your skin cancer will be removed and processed immediately after in our lab. The investigators look at the edges of the skin that the investigators have removed to see if there is any cancer left. If any of the edges show that there is still cancer, the investigators go back and remove more. The investigators will repeat this process until all of the margins of your skin are clear from cancer. After all the cancer is removed, the investigators will reconstruct the area that has been removed to give you the best cosmetic and functional result.
Throughout this procedure, the investigators will inject local anesthetic or "freezing" to reduce the discomfort associated with skin cancer surgery. There are two different types of local anesthetic that the investigators are studying to reduce this pain. One anesthetic is called lidocaine and the other is bupivacaine. A third option is to use a combination of lidocaine and bupivacaine. Lidocaine and bupivacaine are both approved by Health Canada for its use in providing local anesthesia.
WHY IS THIS STUDY BEING DONE? The purpose of this study is to look at which of the approved interventions (lidocaine, bupivacaine or a combination of the two injected sequentially) works best to reduce pain during and after Mohs surgery.
HOW MANY PEOPLE WILL TAKE PART IN THIS STUDY? It is anticipated that about 105 people will take part in this study from The Mohs Clinic at the Parkdale Dermatology Clinic of The Ottawa Hospital.
This study should take three months to complete and the results should be known in about 6 months.
ASSIGNMENT TO A GROUP If you decide to participate then you will be "randomized" into one of the groups described below. Randomization means that you are put into a group by chance (like flipping a coin). There is no way to predict which group you will be assigned to. You will have a one in three chance of being placed in either group. Neither you, the study staff, nor the study doctors can choose what group you will be in.
You will not know which group you are in, but the study doctor and study staff will.
WHAT IS THE STUDY INTERVENTION? Group 1: Lidocaine alone If you are randomized to this group you will receive lidocaine as your local anesthetic.
Group 2: Bupivacaine alone If you are randomized to this group you will receive bupivacaine as your local anesthetic.
Group 3: Lidocaine and bupivacaine used in combination If you are randomized to this group you will receive both lidocaine and bupivacaine used in combination during your procedure. First you will receive injections of lidocaine and then immediately afterwards you will receive injections of bupivacaine. Roughly equal volumes of lidocaine and bupivacaine will be used and the investigators expect the overall volume of local anesthetic (compared with group 1 and 2) that will be injected will be similar. The investigators expect the total number of needle pokes to be similar.
WHAT ELSE DO I NEED TO KNOW ABOUT THE STUDY INTERVENTION? All of the study interventions are considered standard of care for the use of local anesthetics in Mohs procedure. Local practices for using anesthetics are center dependent.
If you have side effects while you are on this study, the study doctor may make changes to the intervention.
If you require greater than three levels during your Mohs procedure, your data will be collected but will be excluded from the main study analysis. Patients requiring greater than three levels during their Mohs procedure are excluded because they often require more complex skin reconstruction surgery which can be more painful afterwards. The vast majority of patients undergoing Mohs surgery require one to three levels and it is these patients that the investigators are hoping to apply the results of our study to.
QUESTIONNAIRES As part of the study, you will be required to complete the same short questionnaire a total of nine times. This questionnaire will only be done by participants in this study.
The questionnaire will be completed at The Mohs Clinic just prior to your surgery and you will complete the questionnaire at home after your surgery at various time points (at 2, 4, 6, 8, 12, 24, 36 and 72 hours post surgery). The purpose of the questionnaire is assess the level of your surgical/incisional pain after Mohs surgery and enquire about any additional pain medications that you have taken after the surgery. It will take approximately 2 minutes to complete the questionnaire You will be asked to bring all of the completed questionnaires with you when you return to the Mohs Clinic for your follow-up visit one the investigatorsek after your surgery.
The information you provide is for research purposes only. You can choose not to ansthe investigatorsr questions if you wish.
Even though you may have provided information on a questionnaire, these responses will not be reviethe investigatorsd promptly by your health care team. If you wish them to know this information please bring it to their attention.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jillian A Macdonald, MD
- Phone Number: 81645 6137388400
- Email: jimacdonald@toh.ca
Study Contact Backup
- Name: Megan C LIM, MD
- Phone Number: 6138891927
- Email: melim@toh.ca
Study Locations
-
-
Ontario
-
Ottawa, Ontario, Canada, K1H 7W9
- Recruiting
- Mohs Surgery Clinic
-
Contact:
- Jillian A Macdonald, MD
- Phone Number: 81645 6137388400
- Email: jimacdonald@toh.ca
-
Contact:
- Megan C LIM, MD
- Phone Number: 6138891927
- Email: melim@toh.ca
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 18 years
- Confirmed diagnosis of non-melanoma skin cancer
- Written informed consent
Exclusion Criteria:
- Documented or reported history of adverse reaction to lidocaine or bupivacaine
- Active soft tissue infection at site of surgery
- Participants who require more than 3 stages of excision
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Lidocaine
Buffered lidocaine 1% with epinephrine 1:200,000 Injected at the start of every Mohs excision stage
|
See Arm Description
|
ACTIVE_COMPARATOR: Bupivacaine
Bupivacaine 0.5% with epinephrine 1:200,000 Injected at the start of every Mohs excision stage
|
See Arm Description
|
ACTIVE_COMPARATOR: Lidocaine and Bupivacaine
Buffered lidocaine 1% with epinephrine 1:200,000 and bupivacaine 0.5% with epinephrine 1:200,000 injected sequentially. Injected at the start of every Mohs excision stage |
See Arm Description
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Wong-Baker FACES Pain Rating Scale
Time Frame: 2, 4, 6, 8, 12, 24, 36, and 72 hours
|
The Wong-Baker Pain Scale is a validated tool used around the world for to quantify patients amount of pain.
The score ranges from 0 (no pain) to 10 (worst pain).
|
2, 4, 6, 8, 12, 24, 36, and 72 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adverse Event
Time Frame: 1 week post-op
|
Adverse event to local anesthetic
|
1 week post-op
|
Post-Operative Infection
Time Frame: 1 week post-op
|
Post-operative infection requiring topical or systemic antibiotics
|
1 week post-op
|
Post-Operative Bleeding
Time Frame: 1 week post-op
|
Post-operative bleeding requiring surgical exploration/revision or hematoma evacuation
|
1 week post-op
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Jillian A Macdonald, MD, The Ottawa Hospital
Publications and helpful links
General Publications
- Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg. 1999 May;57(5):510-4; discussion 515. doi: 10.1016/s0278-2391(99)90063-0.
- Firoz BF, Goldberg LH, Arnon O, Mamelak AJ. An analysis of pain and analgesia after Mohs micrographic surgery. J Am Acad Dermatol. 2010 Jul;63(1):79-86. doi: 10.1016/j.jaad.2009.10.049.
- Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North Am. 2000 Jun;18(2):217-33, v. doi: 10.1016/s0889-8537(05)70161-9.
- Koay J, Orengo I. Application of local anesthetics in dermatologic surgery. Dermatol Surg. 2002 Feb;28(2):143-8. doi: 10.1046/j.1524-4725.2002.01126.x.
- Christensen J, Matzen LH, Vaeth M, Wenzel A, Schou S. Efficiency of bupivacaine versus lidocaine and methylprednisolone versus placebo to reduce postoperative pain and swelling after surgical removal of mandibular third molars: a randomized, double-blinded, crossover clinical trial. J Oral Maxillofac Surg. 2013 Sep;71(9):1490-9. doi: 10.1016/j.joms.2013.05.001. Epub 2013 Jul 15.
- Kaurich MJ, Otomo-Corgel J, Nagy RJ. Comparison of postoperative bupivacaine with lidocaine on pain and analgesic use following periodontal surgery. J West Soc Periodontol Periodontal Abstr. 1997;45(1):5-8.
- Markovic AB, Todorovic L. Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):e4-8. doi: 10.1016/j.tripleo.2006.02.024. Epub 2006 Aug 10.
- Su N, Liu Y, Yang X, Shi Z, Huang Y. Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Apr;64(2):96-107. doi: 10.1111/idj.12087. Epub 2014 Jan 16.
- Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg. 2006 Aug;118(2):429-32. doi: 10.1097/01.prs.0000227632.43606.12.
- Yilmaz YF, Ozlugedik S, Titiz A, Tuncay A, Ozcan M, Unal A. Comparison of levo-bupivacaine and lidocaine for postoperative analgesia following septoplasty. Rhinology. 2008 Dec;46(4):289-91.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Lidocaine
- Bupivacaine
Other Study ID Numbers
- #20160131
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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