Acute Pain Clinical Trial
— PENTRAOfficial title:
Clinical Evaluation of Penthrox (Methoxyflurane)and Tramadol for the Singapore Emergency Ambulance Service
Verified date | February 2017 |
Source | Singapore General Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Introduction
Current practice in Singapore Emergency Ambulance Service (EAS) includes the use of
analgesia delivered via inhalation Enthanox (Nitrous Oxide). However there are difficulties
administering Enthanox on-scene due to the added weight of carrying bulky cylinder tanks. It
is common for a delay in administration of analgesia. Inhaled methoxyflurane (Penthrox) is a
potential agent for early administration of analgesia by Singapore Civil Defense Force
(SCDF) EAS. It is extensively used in the pre-hospital setting in Australia. However data on
its use as an analgesic agent in general are limited and there are few published controlled
trials of methoxyflurane in an analgesic role. Intramuscular (IM) tramadol is a common
medication used in the hospital setting for analgesia. It is well proven, simple to deliver
and is not a controlled drug.
Aim
To compare Penthrox and Tramadol in the treatment of acute pain in patients transported by
the SCDF EAS.
Methodology
The trial will recruit 400 eligible patients over 1 year (200 Penthrox and 200 tramadol).
Patients managed by SCDF EAS for treatment of acute pain and who meet the eligibility
criteria will be recruited into the study. Half of SCDF's 30 ambulances (15 ambulances),
will be randomly assigned, equipped and trained to carry the new medication (Penthrox). The
other half (15 ambulances), will be trained and equipped with tramadol. Allocation will be
on a per station level. After 6 months, they will cross over to Penthrox and tramadol
respectively.
All paramedics will be trained to use both medications, pain scales and Ramsey scores, and
will record patient's pain, sedation scores and patient satisfaction as part of routine
clinical practice. All patients will be followed up by a review of their Emergency
Department and hospital records for any medication related adverse effects.
Hypothesis
The investigators hypothesize that in patients with acute pain (pain score ≥3), presenting
to the ambulance service with musculo-skeletal trauma (limbs or back); pain relief by
inhaled methoxyflurane will be equivalent to IM tramadol, as assessed by Visual Analogue
Scale (VAS) at 5, 10, 15 and 20 min after start of the study treatments.
Status | Completed |
Enrollment | 380 |
Est. completion date | October 2015 |
Est. primary completion date | August 2014 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 16 Years and older |
Eligibility |
Inclusion Criteria: - Patients with acute pain, with pain score greater than 3, presenting with musculo-skeletal trauma (limbs or back) pain are eligible - Conscious, haemodynamically stable condition (BP greater than 90/60) - Age more than 16 years old Exclusion Criteria: General - Females who are nursing or with a positive pregnancy test (pregnant) - Patients with major head injury or impaired consciousness - Acute intoxication with drugs or alcohol, or other conditions that might impair ability to score pain - Chronic pain requiring ongoing use of analgesics - Abdominal or chest pain (for the purpose of this initial implementation study) Penthrox only - Known pre-existing renal or hepatic impairment - Hypersensitivity to fluorinated anaesthetics or a history of possible adverse reactions in either the patients or relatives (malignant hyperthermia) - Concomitant use of nephrotoxic medications such as gentamicin or tetracycline Tramadol only - Any allergies to tramadol or codeine - Any history of seizures, epilepsy - Patients who are taking anti-depressants |
Country | Name | City | State |
---|---|---|---|
Singapore | Singapore Civil Defence Force | Singapore |
Lead Sponsor | Collaborator |
---|---|
Singapore General Hospital |
Singapore,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in Pain Score assessed by Visual Analogue Scale (VAS) | 5, 10, 15 and 20 min | ||
Secondary | Change in Ramsay sedation Scores | 5, 10, 15 and 20 min |
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