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No subjects were enrolled and the sponsor suspended support at this time
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The purpose of this study is to evaluate the clinical performance of the ReLeaf infusion catheter & wound drain in patients following lumbar spinal fusion surgery. One half of the patients will receive continuous local analgesic fusion during the post-operative period while the other half will received continuous local saline.
Posterior lumbar spinal fusion is commonly used in the management of a wide array of spinal disorders ranging from instability to degenerative disc disease. However, severe postoperative pain is a significant adverse outcome in patients who have undergone a lumbar spinal fusion procedure. This pain may delay mobilization and decrease compliance with physical, occupational, or pulmonary physiotherapy.
Pain symptoms may worsen with activity and ambulation due to reflex spasms of the paraspinal muscles elicited by pain from the wound. A local anesthetic agent administered immediately after surgery into the tissue surrounding the wound addresses the pain source for less than four hours. Therefore, it is reasonable to consider continuous local anesthetic infusion, which may limit local pain mediators for a longer duration.
Continuous local anesthetic infusion into the paraspinal musculature with the ReLeaf catheter has the potential to reduce pain, narcotic demand & usage, and accelerate the rate of recovery in lumbar spinal fusion patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ropivacaine | Active Comparator | Continuous 0.2% Ropivacaine infusion until catheter removal (typically 36 hours) |
|
| Saline | Placebo Comparator | Continuous saline infusion until catheter removal (typically 36 hours) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ReLeaf catheter | Device | Continuous infusion rate 10ml/hr (5ml/side) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Pain (Mean VAS pain score at 24 hours post-procedure) | Mean VAS pain score at 24 hours post-procedure | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Medication Use | Narcotic use from surgery through 3 months post-operative | 3 months |
| Adverse Events | Occurrence of adverse events through 3 months post-operative |
| Measure | Description | Time Frame |
|---|---|---|
| Length of Hospital Stay | Time from surgery to hospital discharge, on average 2 to 3 days | Discharge, on average 2 to 3 days |
| Incisional Pain | Pain at the site of the incision at 3 months post-operative |
Inclusion Criteria:
Exclusion Criteria:
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16261108 | Background | Yukawa Y, Kato F, Ito K, Terashima T, Horie Y. A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium. Spine (Phila Pa 1976). 2005 Nov 1;30(21):2357-61. doi: 10.1097/01.brs.0000184377.31427.fa. | |
| 15220788 |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| D012965 | Sodium Chloride |
| D009020 | Morphine |
| D010098 | Oxycodone |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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| Ropivacaine |
| Drug |
|
|
| Saline | Drug |
|
| Morphine | Drug | Patient-controlled analgesia (PCA) at 1mg every 6 minutes with a 4 hour lock out after 30mg |
|
| Oxycodone | Drug | 10mg every 4-6 hours |
|
|
| 3 months |
| 3 months |
| Incidence of nausea and vomiting | Occurrence of nausea with or without vomiting and treatments from time of surgery through hospital discharge (which is 2-3 days on average) | Discharge, on average 2 to 3 days |
| Time of Foley Catheter Removal | Time foley catheter was removed following surgery but no later than hospital discharge (which is 2-3 days on average) | Discharge, on average 2 to 3 days |
| Time to First Ambulate | Time to walk following surgery but no later than hospital discharge (which is 2-3 days on average) | Discharge, on average 2 to 3 days |
| Gottschalk A, Freitag M, Tank S, Burmeister MA, Kreil S, Kothe R, Hansen-Algenstedt N, Weisner L, Staude HJ, Standl T. Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery. Anesthesiology. 2004 Jul;101(1):175-80. doi: 10.1097/00000542-200407000-00027. |
| 14693613 | Background | Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, Guberti A, Massari L. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg. 2004 Jan;98(1):166-172. doi: 10.1213/01.ANE.0000093310.47375.44. |
| 18197109 | Background | Elder JB, Hoh DJ, Wang MY. Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 2008 Jan 15;33(2):210-8. doi: 10.1097/BRS.0b013e318160447a. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D000588 |
| Amines |
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
| D003061 | Codeine |