Peri-operative Oral Pain Control Following Buccal Graft Urethroplasty: Randomized Control Trial of Harvest Site Anesthetic
University of California, San Francisco
Summary
Patients undergoing buccal urethroplasty will often have significant post-operative oral pain from the graft site. Various graft harvest techniques and methods for post-harvest hemostasis including graft site closure have been explored. Despite the frequency of this clinical scenario there is no established best practice for peri-operative pain management in this patient population. In addition to traditional post operative pain control, groups have sought various peri-operative anesthetic regimens to improve post operative pain. This has led recently to the description of various regional blocks including buccal and periorbital blocks for peri-operative local anesthetic. No study has looked at superiority of regional pain management in this patient population. This study will aim to assess three established anesthetic protocols for oral pain control in a blinded, randomized controlled trial. Hypothesis: Patients who have buccal block will have lower post op pain without any increase adverse oral outcomes.
Description
This is a blinded, randomized, controlled trial following patients undergoing buccal urethroplasty (see criteria). This study will aim to assess three established anesthetic protocols for oral pain control. Each study arm holds equal weight. Approximately 60 subjects will be randomized in a 1:1:1 ratio to receive the following graft harvest techniques, which are all considered standard of care. Group 1: Current Buccal Harvest * Infiltration of lidocaine 1% with 1:100,000 epinephrine (maximum 10cc) * Graft site hemostasis with monopolar cautery * No suture closure of graft site Group 2: Basi…
Eligibility
- Age range
- 18+ years
- Sex
- Male
- Healthy volunteers
- No
Inclusion Criteria: * Men, age 18 or older * Undergoing anterior urethroplasty with buccal grafting * Able to consent Exclusion Criteria: * Taking chronic opiates for pain * Diagnosis of chronic pain * Prior buccal urethroplasty * Vulnerable population (e.g. prisoner) * Renal dysfunction or allergy preventing NSAID use * Liver dysfunction or allergy preventing Tylenol use * Medical allergy to local anesthetic * Medical allergy to Peridex/Magic Mouthwash * NYHA Class III/IV * Hematologic condition that excludes patient from surgery * Post-operative complication resulting in inpatient stay *…
Interventions
- DrugStandard Buccal Harvest
Our institutions current anesthetic regimen. Comparison group
- DrugBasic buccal procedure + Long acting local
Addition of long-acting local anesthetic to the wound bed following the oral graft harvest.
- DrugBasic buccal procedure + Buccal block
Addition of long-acting local anesthetic as a buccal block after oral graft harvest
Locations (2)
- University of California San FranciscoSan Francisco, California
- MedStar UrologyWashington D.C., District of Columbia