Analgesia Clinical Trial
Official title:
Precision Perioperative Methadone Use in Adult Cardiac Surgical Patients to Reduce Opioid Use Adverse Effects While Improving Analgesia and Outcomes
The proposed research is an important extension of an ongoing perioperative personalized analgesia and intravenous opioid pharmacogenetic research. This research focuses on two of the most commonly used oral opioid analgesics, oxycodone, and methadone in elderly adults undergoing cardiac surgery.
Status | Not yet recruiting |
Enrollment | 400 |
Est. completion date | December 1, 2026 |
Est. primary completion date | December 1, 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 60 Years to 110 Years |
Eligibility | Inclusion Criteria: - Elderly cardiac surgical patients over 60 years of age Exclusion Criteria: - Methadone allergy - Morbid obesity (BMI >40kg/cm2) - Severe sleep apnea - Severe pulmonary disease requiring oxygen therapy - Preoperative mechanical circulatory support - Emergency surgery - Liver disease (liver enzymes more than two times normal) - End-stage renal disease requiring dialysis - Serum creatinine more than 2.0mg |
Country | Name | City | State |
---|---|---|---|
United States | UPMC Presbyterian Hospital | Pittsburgh | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
Kathirvel Subramaniam |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Determine Genetic Factors - Opioid Related Adverse Events (RD) | Respiratory depression will be measured with binary yes/no responses obtained either via self-report from the patient or reported by the clinical care staff. | Immediately post-surgery during hospital stay | |
Primary | Determine Genetic Factors - Opioid Related Adverse Events (PONV) | Post-operative nausea and vomiting will be measured with binary yes/no responses obtained either via self-report from the patient or reported by the clinical care staff. | Immediately post-surgery during hospital stay | |
Primary | Determine Genetic Factors - Opioid Related Adverse Events (Excessive Sedation) | Excessive sedation will be measured with binary yes/no responses obtained either via self-report from the patient or reported by the clinical care staff. | Immediately post-surgery during hospital stay | |
Primary | Determine Genetic Factors - Uncontrolled severe pain | We postulate that specific CYP2B6, ABCB1, OPRM1, FAAH, and ORM1 genetic variants identify patients at risk for poor pain relief and ORADE with methadone in the immediate post-surgical period. Pain will be measured by the Numerical Rating Scale (NRS) in which 0 = no pain at all and 10 = worst pain imaginable. This will be self-reported responses by the patient. | Immediately post-surgery during hospital stay | |
Secondary | Opioid use post-operatively | Opioid usage will be recorded via SOAPP-R, a 24-item validated opioid assessment. A score of 18 or higher is considered positive. | POD 5 to 6-months post-operative | |
Secondary | Patient-Reported Outcomes Measurement Information System | The PROMIS-29 v2.0 will be collected for this outcome measure. The PROMIS survey is scored by the following T-Score Cut Points: 20-55 = better health, 55-60 = mild, 61-69 = moderate, and 71+ = worse health. The general population mean = 50 (SD = 10). | POD 5 to 6-months post-operative | |
Secondary | Incidence of Chronic Persistent Surgical Pain (CPSP) | CPSP will be obtained via patient-self report as yes/no responses for follow-up assessments. This measure will be reported as mean(SD) for positive CPSP subjects. | POD 5 to 6-months post-operative |
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