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Trial registered on ANZCTR
Registration number
ACTRN12605000241639
Ethics application status
Approved
Date submitted
29/08/2005
Date registered
31/08/2005
Date last updated
31/08/2005
Type of registration
Prospectively registered
Titles & IDs
Public title
The WIPPET Study
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Scientific title
The effect of levobupivicaine Wound Infusion, for 24 hours, on Postoperative Pain after caEsarean secTion - a prospective, randomised, double-blind parallel-group placebo controlled clinical trial.
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Universal Trial Number (UTN)
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Trial acronym
WIPPET
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Postoperative analgesia after caesarean section
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Condition category
Condition code
Surgery
376
376
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0
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Other surgery
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
To determine whether levobupivicaine, administered by wound infiltration and continuous infusion into the rectus sheath (using Go Medical Balloon Infusor Catheter) is effective in reducing postoperative opioid requirements.
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Intervention code [1]
283
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Treatment: Drugs
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Comparator / control treatment
Parallel group will receive saline instead of levobupivicaine.
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Control group
Placebo
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Outcomes
Primary outcome [1]
435
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Efficacy of pain relief as assessed by pain score (visual analogue scale - VAS)
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Assessment method [1]
435
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Timepoint [1]
435
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During movement and at 6 and 24 hours.
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Secondary outcome [1]
951
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Cumulative postoperative morphine dose requirement.
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Assessment method [1]
951
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Timepoint [1]
951
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To 6 and 24 hours.
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Secondary outcome [2]
952
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Pain scores at rest and on movement
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Assessment method [2]
952
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Timepoint [2]
952
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At 2, 6, 24 and 48 hours postoperatively.
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Secondary outcome [3]
953
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Global assessment of pain
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Assessment method [3]
953
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Timepoint [3]
953
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From end of surgery until 24 hours (nil; mild; moderate; severe).
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Secondary outcome [4]
954
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Incidence and severity of side effects
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Assessment method [4]
954
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Timepoint [4]
954
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0-10 numerical rating score or ordinal scales for postoperative nausea and vomiting, sedation, pruritus.
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Secondary outcome [5]
955
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Presence of symptoms associated with premonitory central nervous system local anaesthetic toxicity.
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Assessment method [5]
955
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Timepoint [5]
955
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Secondary outcome [6]
956
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Time to first ambulation.
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Assessment method [6]
956
0
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Timepoint [6]
956
0
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Secondary outcome [7]
957
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Time to first oral food intake.
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Assessment method [7]
957
0
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Timepoint [7]
957
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Secondary outcome [8]
958
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Satisfaction with pain relief (0-100 VAS).
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Assessment method [8]
958
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Timepoint [8]
958
0
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Secondary outcome [9]
959
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Wound healing
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Assessment method [9]
959
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Timepoint [9]
959
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Incidence of wound dehiscence or infection on day 4 postoperatively and at 30 days as assessed by a telephone call to the patient to determine presence of wound edge separation since discharge.
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Secondary outcome [10]
960
0
Venous levobupivicaine concentrations
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Assessment method [10]
960
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Timepoint [10]
960
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At baseline and at set time intervals after wound infiltration and during continuous wound irrigation for a 21 hour postoperative period and until 4 hours after cesstion of the infusion (for 20 patients in study only).
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Eligibility
Key inclusion criteria
ASA 1 or 2. Elective caesarean section with pfannensteil incision. Consent for spinal anesthesia and postoperative patient controlled intravenous morphine analgesia (PCIA).
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Minimum age
18
Years
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Maximum age
Not stated
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
History of allergy to amide local anaesthetic or morphine.Current opioid use excluding codeine.Patients unsuitable for PCIA system.Anaesthesia other than spinal anaesthesia.Surgical incision other than pfannensteil.Surgery other than caesarean section (inlcuding tubal ligation).Requirement for administration of local anaesthetic at other sites during the procedure. Surgical decision to insert a wound drainage catheter.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Infiltration solutions to be prepared by anaesthetist not involved in study. Solutions coded to maintain blinding of patient and observers. Allocation using sealed opaque envelopes.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated sequence
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
9/02/2006
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
76
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
432
0
Commercial sector/Industry
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Name [1]
432
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Abbott Australasia
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Address [1]
432
0
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Country [1]
432
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Australia
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Primary sponsor type
Individual
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Name
Dr Sharon Smedley
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Address
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Country
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Secondary sponsor category [1]
350
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Individual
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Name [1]
350
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Professor Michael Paech
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Address [1]
350
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King Edward Memorial Hospital for Women
374 Bagot Road
Subiaco
Perth WA 6008
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Country [1]
350
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
1401
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King Edward Memorial Hospital for Women
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Ethics committee address [1]
1401
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374 Bagot Road, Subiaco, Perth, WA, 6008
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Ethics committee country [1]
1401
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Australia
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Date submitted for ethics approval [1]
1401
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Approval date [1]
1401
0
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Ethics approval number [1]
1401
0
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Summary
Brief summary
The aim of this study is to determine whether infiltration and then continuous infusion of the wound with local anaesthetic reduces pain after caesarean section. Secondary outcomes include the effect on the need for opioid pain killers (e.g. morphine) and recovery after caesarean section. Currently the common methods used for post-caesarean pain relief include opioid pain killers (intravenous and oral), non-steroidal anti-inflammatory drugs, paracetamol and epidural analgesia. Opioids have unwanted side effects such as drowsiness, nausea and vomiting, itchiness and constipation, and pass to the newborn in breast milk. Epidural analgesia requires an indwelling epidural catheter and has infection risks, as well as being labour intensive. Numerous studies have looked at the effectiveness of local anaesthetics administered by infiltration and/or infusion as a means of postoperative analgesia after abdominal surgery. Several demonstrated a clear benefit to this approach, while others found no advantage. Two studies of wound infusion following caesarean delivery showed a reduced need for opioid painkillers but the new local anaesthetic levobupivicaine has not yet been studied for wound infusion. Recently, two wound infusion catheters have been developed to aid local anaesthetic infusion to surgical wounds. Information on absorption of local anaesthetics into the blood after wound infiltration is limited. Bupivicaine is the most widely used local anaesthetic. A study determined venous bupivicaine levels follwing total abdominal field block but this regimen did not inlcude continuous infusion. The effects of repeated ropivacaine instillation into the wound has been assessed and unbound ropivacaine concentrations were below the toxic range, however accumulation was noted. An alternative to bupivucaine and ropivicaine is levobupivicaine which has a better side effect profile than bupivicaine. There is no information about its absortion after wound instillation. A second aim of this study would be to determine venous levobupivicaine concentraions resulting from wound infiltration and a 24 hour postoperative period of irrigation by infusing through a wound catheter.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
35989
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Address
35989
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Country
35989
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Phone
35989
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Fax
35989
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Email
35989
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Contact person for public queries
Name
9472
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Professor Michael Paech or Research Nurses, Desiree Cavill & Tracy Bingham
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Address
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King Edward Memorial Hospital for Women
374 Bagot Road
Subiaco Perth WA 6008
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Country
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Australia
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Phone
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+61 8 93402222 Pager 3223 (Mike Paech) or 3433 (Research Nurses)
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Fax
9472
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+61 8 93402260
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Email
9472
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[email protected]
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Contact person for scientific queries
Name
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Professor Michael Paech
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Address
400
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King Edward Memorial Hospital for Women
374 Bagot Road
Subiaco Perth WA 6008
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Country
400
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Australia
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Phone
400
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+61 8 93402222 Pager 3223
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Fax
400
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+61 8 93402260
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Email
400
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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