Cesarean Section Clinical Trial
Official title:
Efficacy of Epidural Analgesia Versus Single Dose Injection of Naldebain® in Management of Acute and Chronic Surgical Pain After Cesarean Section in Term Parturient - a PI-initiated, Randomized, Open-label, Non-inferiority Clinical Trial
Inadequate postoperative pain management can lead to physical and psychological distress in patients as well as impact surgical wound healing and increase the risk of developing postoperative delirium and cardiopulmonary and thromboembolic events. Severe postoperative pain may also result in the development of chronic post-surgical pain (CPSP), which in turn can lead to prolonged use of opioids and increased health-care costs. A descriptive survey study in 60 postpartum women who received cesarean section suggested that the presence of postoperative pain significantly reduced the willingness of breastfeeding and infant care. The incidence of CPSP after cesarean delivery has been reported to vary from 1% to 18% up to 1 year after operation. Patient-controlled epidural analgesia (PCEA) is considered as the standard pain management strategy for post-cesarean pain. However, correct placement of epidural catheter for effective postoperative pain management is more technical demanding, and accidental dural puncture is associated with increased risk of postdural puncture headache. It also increases risk of other complications, including urinary retention, systemic toxicity of local anesthetics and formation of epidural hematoma. Therefore, the development of a safe, conveniently operated, and long-lasting analgesic strategy, which serves as background pain control modality up to several days after cesarean section should provide clinically beneficial advantages in the management of acute postoperative pain and prevention of CPSP in postpartum women. Naldebain® is prodrug of nalbuphine, which was approved by the Taiwan FDA in 2017. Naldebain® is rapidly hydrolyzed by tissue of plasma esterase to release nalbuphine. The bioavailability of nalbuphine following intramuscular injection Naldebain® was 85.4%, and it took approximately 6 days for the complete release of Naldebain® into the blood circulation. Therefore, a single parenteral injection of Naldebain® could provide long lasting analgesic effect in several phase II trials. However, Naldebain® has not been tested in the pain control after cesarean section. Therefore, this PI-initiated prospective, randomized, open-label, non-inferiority trial aims to investigate the clinical efficacy of Naldebain® in management of acute postoperative pain in term parturient who receive elective cesarean section to provide analgesic effect that is not inferior to the standard PCEA and prevent the development of CPSP.
Status | Not yet recruiting |
Enrollment | 120 |
Est. completion date | October 1, 2023 |
Est. primary completion date | June 30, 2023 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 20 Years and older |
Eligibility | Inclusion Criteria: - Term primipara or multipara Exclusion Criteria: - Severe pregnancy-induced complication (such as preeclampsia, eclampsia, poorly control pregnancy-induced hypertension and/or diabetes) - High risk for postpartum hemorrhage - Contraindications for neuraxial block - Preterm (gestational age< 36 week) delivery - Emergency cesarean section - After-office hour schedule - History of substance abuse - Known allergy to nalbuphine, benzyl benzoate or sesame oil - Not willing to follow the assignment of treatment after randomization |
Country | Name | City | State |
---|---|---|---|
Taiwan | E-Da Hospital | Yanchao | Kaohsiung |
Lead Sponsor | Collaborator |
---|---|
E-DA Hospital |
Taiwan,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Intensity of surgical pain after operation as assessed by visual analogue scale | Visual analogue scale (VAS 1-10, a continuum scale in which 0 represents "no pain" and and 10 represents "worst pain.") | 5 days after operation | |
Primary | Rescue doses of analgesics administered after operation | Total doses of parenteral administered opioids, NSAIDs, COX-2 inhibitors | 5 days after operation | |
Secondary | Incidence of chronic post-surgical pain | Pain that newly develops after operation and lasts >2 months and other causes of pain are excluded | 3 months after operation | |
Secondary | Satisfaction of living after surgery as assessed by the HRQoL SF-12 | Quality of life will be assessed by the HRQoL SF -12 Questionnaire, which consists a physical component summary (PCS) and a mental component summary (MCS). The rating scales range from yes-no to likert scales, and the final score of PCS and MCS will be calculated by an algorithm (QualityMetric's SF-12v1®). Scores range from 0 to 100, in which lower scores mean lower health related quality of life | 3 months after operation |
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