Pain Relief at Iliac Crest Bone Harvest Sites in Spine Surgery Using Bupivacaine
Local Anesthetic Use at Iliac Crest Bone Graft Site in Spinal Reconstructive Surgery
研究概览
详细说明
The use of local anesthetic at the donor site has been investigated to decrease the morbidity of iliac crest bone harvesting. Along with a decrease in early post-operative pain that may be expected a decrease in chronic pain and improved long-term results have also been demonstrated. Local anesthetics may cause such long-term results by dampening the initial chemical response to injury by reducing the release of inflammatory mediators from neutrophils, neutrophil adhesion to the endothelium, and the formation of free oxygen radicals. Most studies have utilized continuous or periodic infusions of anesthetic through a catheter placed at the time of surgery for 24-48 hours postoperatively. The drawbacks to using a catheter include increased infection risk and increased cost if a continuous infusion is used . A single treatment of local anesthetic at the time of surgery is therefore preferable. Only one study has evaluated a single injection of local anesthetic in adult spine patients, demonstrating decreased pain and narcotic usage through 5 post-operative days. No study to date has demonstrated a decrease in intermediate or long-term donor site pain through a single application of anesthetic, as achieved in previous studies utilizing post-operative infusions via a catheter.
Participants in the study will be identified in by the attending surgeons on this study who are clinical faculty within the department of orthopaedics and board certified in spine surgery. Randomization will be done by random selection of a sealed envelope by the attending physician at the time of enrollment. Sealed envelopes will contain a paper that assigns the patient to the treatment (bupivacaine at bone harvest site) or placebo (normal saline at bone harvest site) group. Note that all surgical wounds are routinely irrigated with normal saline prior to skin closure. In the control group, 10ml more of normal saline will be used in the ICBG site. In the treatment group, 10ml of bupivacaine 0.5% will be administered directly into the surgical wound, as done in some cases currently. Therefore, there are no new procedures in this protocol outside of what is already being done in practice. The current practice of using versus not using local anesthetic at the iliac crest bone graft site is at the discretion of the attending surgeon. Please note that the randomization in this study has nothing to do with the surgery that is done, and all patients will be treated according to standard of care regardless of this randomization. There are no other differences between treatments in the two study groups. There are no deviations from normal post-operative care received.
Patients will not be told whether or not they receive bupivacaine at the iliac crest bone graft site at the time of surgery. The patient will be blinded to their treatment group throughout the study. At the patient's request, they will be informed of their treatment group at the end of the study. The attending surgeon will not be blinded to the treatment group. The PI will not be blinded to the treatment group.
Background information about the patient and a pain assessment will be done at the time of enrollment by asking participants to fill out a paper questionnaire. Paper questionnaires to assess the patient's pain level will be given to and collected from patients at discharge from the hospital, the first follow up appointment (approximately 2-4 weeks postoperatively), and at the next follow up appointment (approximately 3 months postoperatively). In addition, patients will be given a paper narcotics log to enter their daily oral narcotic usage between the time of discharge and their first follow up appointment.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Tennessee
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Nashville、Tennessee、美国、37209
- Vanderbilt Medical Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- patients 18 years of age or older undergoing posterior cervical, thoracic, or lumbar surgery
- willingness to participate in the study.
Exclusion Criteria:
- individuals who underwent surgical intervention in the past 6 months
- previous iliac crest bone harvesting
- history of tumor and spondyloarthropathies (rheumatoid arthritis, seronegative arthritis)
- history of adverse reaction to local anesthetic
- history of severe pelvic and hip conditions that can interfere with the outcome assessment of the study
- opioid addiction
- pregnancy
- acute mental illness
- uncontrolled major depression and any other psychiatric disorders
- prisoners
- non-english speaking patients
- inability to understand the informed consent and demands of the study.
学习计划
研究是如何设计的?
设计细节
- 主要用途:预防
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
有源比较器:Bupivacaine
This group will receive bupivacaine (10ml of 0.5%) administered directly into the surgical wound at the iliac crest bone harvest site.
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Single application of 10ml of bupivacaine 0.5% into the iliac crest bone harvest surgical site.
其他名称:
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安慰剂比较:Saline
This group will receive normal saline (10ml) administered directly into the surgical wound at the iliac crest bone harvest site.
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Normal saline 0.9%, 10ml, single application directly into iliac crest bone harvest surgical site.
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Pain, Cumulative Visual Analog Score, 1st Follow Up
大体时间:about 4 to 5 weeks after surgery
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Cumulative Visual Analog Score pain score scores were calculated using the sum of scores (at rest and with movement, pain on average at rest and with movement, and maximum pain at rest and with movement) Range = 0-60 for cumulative visual analog pain score with 0=no pain and 60=worst pain ever.
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about 4 to 5 weeks after surgery
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Pain, Cumulative Visual Analog Score, Final Follow up
大体时间:about 18 to 20 weeks after surgery
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Cumulative Visual Analog Score pain score scores were calculated using the sum of scores (at rest and with movement, pain on average at rest and with movement, and maximum pain at rest and with movement) Range = 0-60 for cumulative visual analog pain score with 0=no pain and 60=worst pain ever.
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about 18 to 20 weeks after surgery
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Narcotic Use, 1st Follow up
大体时间:about 4 to 5 weeks after surgery
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Number of participants using narcotics for pain
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about 4 to 5 weeks after surgery
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Narcotic Use, Final Follow up
大体时间:about 18 to 20 weeks after surgery
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Number of participants using narcotics for pain
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about 18 to 20 weeks after surgery
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合作者和调查者
调查人员
- 首席研究员:Kevin R O'Neill, MD, MS、Vanderbilt University Medical Center, Department or Orthopaedics
- 学习椅:Richard A Davis, MD、Vanderbilt University Medical Center, Department or Orthopaedics
- 学习椅:Clint Devin, MD、Vanderbilt University Medical Center, Department or Orthopaedics
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他研究编号
- 100096
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