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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04475029
Other study ID # 004581
Secondary ID 2019-004581-18
Status Completed
Phase N/A
First received
Last updated
Start date July 6, 2020
Est. completion date August 17, 2023

Study information

Verified date April 2023
Source University of Aarhus
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The role of a single-dose intraoperative methadone on postoperative pain and opioid consumption in patients undergoing Surgeon Accuracy Robot Assistant cystectomy. A prospective double-blind, randomized controlled trial investigating the effect of a single-dose of intraoperative methadone in patients undergoing robotassisted cystectomy.


Description:

During early recovery after surgery, intravenous opioids are typically administered to control the pain, either as intermittent bolus administration by nursing staff or by a patient-controlled analgesia device. Unfortunately, repeated doses or boluses of shorter-acting opioids, such as morphine, oxycodone and fentanyl, result in fluctuating blood concentrations, with the inherent risk of only relatively brief periods of adequate pain relief. Moreover, the use of shorter-acting opioids increases the risk of opioid-associated side effects, such as sedation, nausea and vomiting. An alternative approach to the postoperative use of shorter-acting opioids is therefore called for. In this respect, methadone is an opioid with unique pharmalogical properties that may be advantageous when applied intraoperatively. A single-dose of this long acting opioid could provide a stable analgesia and potentially reduce the need for shorter-acting opioids Method: 110 patients will be included in an investigator-initiated, prospective, randomised, double-blind, controlled trial with two arms: intervention arm (methadone 0.15 mg/kg ideal body weight). Control arm (morphine 0.15 mg/kg ideal body weight). The study will be GCP-monitored, and is approved by the Danish Health and Medicines Authority (2020041652) and the Central Denmark Region Committees on Health Research Ethics (1-10-72-275-19). Hypothesis We hypothesize that a single-dose of intravenous intraoperative methadone is efficient and safe for the treatment of postoperative pain after cystectomy. Objectives The primary objective is to determine whether a single-dose of intravenous methadone reduces postoperative opioid consumption when compared to morphine. The secondary objectives are to compare the effect and safety of intravenous methadone and morphine on postoperative pain, side effects, patient satisfaction and length of stay.


Recruitment information / eligibility

Status Completed
Enrollment 114
Est. completion date August 17, 2023
Est. primary completion date August 15, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years to 110 Years
Eligibility Inclusion Criteria: - All patients (=18 years) scheduled for elective robot assisted cystectomy. Exclusion Criteria: - American Society of Anesthesiologists (ASA) physical status IV or V - Prolonged QTc-interval assessed by electrocardiogram (> 440 milliseconds) - Existing treatment with a high risk of QTc-interval prolongation - Allergy to study drugs - Preoperative daily use of opioids - Inability to provide informed consent - Severe respiratory insufficiency (oxygen treatment at home) - Heart failure (ejection fraction < 30%) - Acute abdominal pain - Signs of severe liver dysfunction (cirrhosis, inflammation/hepatitis or liver malignancy) - Severe kidney insufficiency (estimated Glomerular Filtration Rate < 30 ml/min) - Treatment with rifampicin - Phaeochromocytoma - Treatment with MAO-inhibitor during the last 14 days - Pregnancy - Nursing mothers - Intraoperative conversion to open surgery (secondary inclusion criterion) - Epidural analgesia in relation to surgical procedure

Study Design


Intervention

Drug:
Methadone
One intravenous administration of methadone (0.15 mg/kg treatment weight (height(cm)-100)) one hour prior to expected extubation.
Morphine
One intravenous administration of morphine (0.15 mg/kg treatment weight (height(cm)-100)) one hour prior to expected extubation.

Locations

Country Name City State
Denmark Aarhus University Hospital Aarhus

Sponsors (1)

Lead Sponsor Collaborator
University of Aarhus

Country where clinical trial is conducted

Denmark, 

Outcome

Type Measure Description Time frame Safety issue
Other Pain intensity • Pain intensity (NRS, 0-10) at rest and coughing, questionnaires answered by nurse. 32-72 hours
Other PONV • Nausea and/or vomiting (PONV) on a 4-point Likert scale (none/mild/moderate/severe). Questionnaires answered by nurse. 32-72 hours
Other Gastrointestinal function Gastrointestinal function (flatus, stools) and laxatives ordained. 6-72 hours
Primary Opioid consumption (morphine mg equivalents) • Opioid consumption within the first 3 hours after extubation 3 hours
Primary Opioid consumption (morphine mg equivalents) • Opioid consumption within the first 24 hours after extubation 24 hours
Secondary Pain intensity NRS (0-10) at rest and when coughing. Questionnaires answered by nurse. within 24 hours
Secondary Opioid consumption (morphine mg equivalents) • Opioid consumption within the first 72 hours after extubation 72 hours
Secondary PONV • Nausea and/or vomiting (PONV) on a 4-point Likert scale (none/mild/moderate/severe). Questionnaires answered by nurse. Within 24 hours
Secondary Level of sedation Level of sedation (Ramsey Sedation Score) assessed by PACU nurse. 3 hours
Secondary Adverse events Any adverse events registered. 6 hours
Secondary Patient satisfaction from 0-10. Patient satisfaction with pain management (NRS 0-10) Questionnaires answered by nurse. 24 hours
Secondary Discharge • Time from arrival to discharge from PACU and hospital (hours and minutes) 6 days
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