Exparel Injection Effect on Postoperative Opioid Usage

Study Overview
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Brief Summary
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The question proposed by this study, is one of patient outcomes. Does intraoperative injection of Exparel decrease postoperative use of opioid pain medications in patients undergoing thyroid and parathyroid surgery? The trial seeks to assess the effect that Exparel has on postoperative pain control.

Detailed Description
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Patients will be identified in clinic as good candidates for surgical intervention based on current standard of care. Once participants are consented, they will be randomly placed into one of three categories. The first category being patients undergoing surgery with local injection of lidocaine and epinephrine as is current practice. The second category of patients will undergo surgery with local injection of bupivacaine HCL and epinephrine preincision. The third group will undergo surgery with local injection of lidocaine and epinephrine preincision and Exparel postincision. As stated above, all patients will undergo surgery as planned, which will be standard of care, with the exception of the local anesthetic and timing of the injection. Postoperatively, patient's pain scores and opioid usage will be evaluated. Patients will be monitored by either using the patient's electronic medical record or by a pain journal that will be provided to the patients. The patients will record their pain using a scale of 1-10 with the FACES scale, as well as medication usage. Patients will return to their first postoperative appointment to further discuss their pain levels as well as medication usage. An ANOVA test will be used to determine if there is a significant difference in the amount of opioids taken postoperatively, in oral morphine equivalents, between these three groups. Opioid usage will then be compared between participants in different categories of local anesthetic to determine if there is an effect of postoperative opioid usage between different anesthetics.

Official Title
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Intraoperative Injection of Exparel Effect on Postoperative Opioid Use in Thyroid and Parathyroid Surgery

Conditions
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Thyroid, Parathyroid Adenoma

Intervention / Treatment
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* Drug: Lidocaine Epinephrine
* Drug: Bupivacaine Hydrochloride-EPINEPHrine
* Drug: Lidocaine Epinephrine, Bupivacaine Hydrochloride-EPINEPHrine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over the age of 18 years Patients requiring parathyroid/thyroid surgery based on the standard of care English as primary language Exclusion Criteria: Patients under the age of 18 years Patients with previous history of opioid abuse Patients with a true allergy to any local anesthetic Patients with a true allergy to any opioid

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Prospective, randomized research study to evaluate postoperative pain medication usage in patients scheduled and receiving thyroid/parathyroid surgery. Patients will be randomized into three different study groups, each receiving a different regiment of treatment.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Current Practice<br>Thyroid or parathyroid surgery with local injection of lidocaine and epinephrine preincision, as is current practice. | Drug: Lidocaine Epinephrine<br>* Preincision injection, as is current practice<br>|
| Experimental: Bupivicaine HCL<br>Thyroid or parathyroid surgery with local injection of bupivicaine HCL and Epinephrine preincision. | Drug: Bupivacaine Hydrochloride-EPINEPHrine<br>* Preincision injection<br>* Other names: Exparel;|
| Experimental: Exparel Injection<br>Thyroid and parathyroid surgery with local injection of lidocaine and epinephrine preincison and Exparel postincision | Drug: Lidocaine Epinephrine, Bupivacaine Hydrochloride-EPINEPHrine<br>* Preincison injection of lidocaine and epinephrine and a postincision injection of Exparel<br>* Other names: Exparel;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of opioid use when given Exparel intraoperatively | Utilizing pain scale daily diary, we will evaluate the incidence of opioid usage in patients that have undergone thyroid/parathyroid surgery | After surgery, patients will be monitored for two weeks, until they return for their first postoperative appointment. |