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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT05025228
Other study ID # Prot. 36041/19 ID: 2727
Secondary ID
Status Completed
Phase
First received
Last updated
Start date June 1, 2019
Est. completion date June 30, 2020

Study information

Verified date June 2020
Source Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The purpose of this study is to monitor severe pain for femur fracture after treatment with paracetamol IV or OR.


Description:

The investigators enrolled 170 consecutive patients with femur fracture and severe pain. The patients received an initial analgesic treatment with paracetamol orally (OR) or intravenously (IV). The primary outcome was the reduction of pain of 1 point at visual analogue scale for pain (VAS) after the 1 st hour of treatment (T1). Secondary endpoints included the reduction of pain of at least 2 points on the VAS scale at the 4 th hour (T4), the need of rescue therapy and the number of adverse events.


Recruitment information / eligibility

Status Completed
Enrollment 170
Est. completion date June 30, 2020
Est. primary completion date June 30, 2020
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Age = 18 years - Patients admitted to the ED of Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome - Femur Fracture - Patients who signed the informed consent - Able to take analgesic therapy both orally (OR) and intravenously (IV) - Able to define pain by VAS Exclusion Criteria: - Age <18 years - Allergy to paracetamol - Unable to take analgesic therapy both orally (OR) and intravenously (IV) - Unable to define pain by VAS

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Paracetamol
Paracetamol given orally or intravenously

Locations

Country Name City State
Italy Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Roma

Sponsors (1)

Lead Sponsor Collaborator
Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Country where clinical trial is conducted

Italy, 

References & Publications (31)

Aprato A, Bechis M, Buzzone M, Bistolfi A, Daghino W, Massè A. No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality. J Orthop Traumatol. 2020 Aug 30;21(1):12. doi: 10.1186/s10195-020-00550-y. — View Citation

Bonnin MP, Neto CC, Aitsiselmi T, Murphy CG, Bossard N, Roche S. Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty - why? Bone Joint J. 2015 Jun;97-B(6):741-8. doi: 10.1302/0301-620X.97B6.35022. — View Citation

Chuang PY, Shen SH, Yang TY, Huang TW, Huang KC. Non-steroidal anti-inflammatory drugs and the risk of a second hip fracture: a propensity-score matching study. BMC Musculoskelet Disord. 2016 May 4;17:201. doi: 10.1186/s12891-016-1047-2. — View Citation

Di Filippo A, Magherini M, Ruggiano P, Ciardullo A, Falsini S. Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study. Aging Clin Exp Res. 2015 Jun;27(3):281-5. doi: 10.1007/s40520-014-0272-5. Epub 2014 Sep 17. — View Citation

Di Sanzo M, Cipolloni L, Borro M, La Russa R, Santurro A, Scopetti M, Simmaco M, Frati P. Clinical Applications of Personalized Medicine: A New Paradigm and Challenge. Curr Pharm Biotechnol. 2017;18(3):194-203. doi: 10.2174/1389201018666170224105600. Review. — View Citation

Dixon J, Ashton F, Baker P, Charlton K, Bates C, Eardley W. Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol. Geriatr Orthop Surg Rehabil. 2018 Oct 25;9:2151459318806443. doi: 10.1177/2151459318806443. eCollection 2018. — View Citation

Dizdarevic A, Farah F, Ding J, Shah S, Bryan A, Kahn M, Kaye AD, Gritsenko K. A Comprehensive Review of Analgesia and Pain Modalities in Hip Fracture Pathogenesis. Curr Pain Headache Rep. 2019 Aug 6;23(10):72. doi: 10.1007/s11916-019-0814-9. Review. — View Citation

Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop. 2018 Jan;42(1):191-196. doi: 10.1007/s00264-017-3665-1. Epub 2017 Nov 7. — View Citation

Fabi DW. Multimodal Analgesia in the Hip Fracture Patient. J Orthop Trauma. 2016 May;30 Suppl 1:S6-S11. doi: 10.1097/BOT.0000000000000561. Review. — View Citation

Franceschi F, Marsiliani D, Alesi A, Mancini MG, Ojetti V, Candelli M, Gabrielli M, D'Aurizio G, Gilardi E, Adducci E, Proietti R, Buccelletti F. A simplified way for the urgent treatment of somatic pain in patients admitted to the emergency room: the SUPER algorithm. Intern Emerg Med. 2015 Dec;10(8):985-92. doi: 10.1007/s11739-015-1304-7. Epub 2015 Sep 4. — View Citation

Gangavalli AK, Nwachuku CO. Management of Distal Femur Fractures in Adults: An Overview of Options. Orthop Clin North Am. 2016 Jan;47(1):85-96. doi: 10.1016/j.ocl.2015.08.011. Review. — View Citation

Gazelka HM, Leal JC, Lapid MI, Rummans TA. Opioids in Older Adults: Indications, Prescribing, Complications, and Alternative Therapies for Primary Care. Mayo Clin Proc. 2020 Apr;95(4):793-800. doi: 10.1016/j.mayocp.2020.02.002. Review. — View Citation

Gemmati D, Varani K, Bramanti B, Piva R, Bonaccorsi G, Trentini A, Manfrinato MC, Tisato V, Carè A, Bellini T. "Bridging the Gap" Everything that Could Have Been Avoided If We Had Applied Gender Medicine, Pharmacogenetics and Personalized Medicine in the Gender-Omics and Sex-Omics Era. Int J Mol Sci. 2019 Dec 31;21(1). pii: E296. doi: 10.3390/ijms21010296. Review. — View Citation

Glinkowski W, Narloch J, Krasuski K, Sliwczynski A. The Increase of Osteoporotic Hip Fractures and Associated One-Year Mortality in Poland: 2008-2015. J Clin Med. 2019 Sep 18;8(9). pii: E1487. doi: 10.3390/jcm8091487. — View Citation

Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019 Jul 4;14(1):203. doi: 10.1186/s13018-019-1226-6. — View Citation

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. doi: 10.1002/acr.20543. Review. — View Citation

Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012 Sep;23(9):2239-56. Epub 2012 Mar 15. Review. — View Citation

Larsen P, Ceccotti AA, Elsoe R. High mortality following distal femur fractures: a cohort study including three hundred and two distal femur fractures. Int Orthop. 2020 Jan;44(1):173-177. doi: 10.1007/s00264-019-04343-9. Epub 2019 May 12. — View Citation

Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med (Lond). 2020 Aug 2;81(8):1-10. doi: 10.12968/hmed.2020.0215. Review. — View Citation

Lim SJ, Yeo I, Yoon PW, Yoo JJ, Rhyu KH, Han SB, Lee WS, Song JH, Min BW, Park YS. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018 Nov;29(11):2427-2435. doi: 10.1007/s00198-018-4640-4. Epub 2018 Jul 23. — View Citation

Makkar JK, Jain K, Kuberan A, Balasubramanian M, Bhatia N, Singh PM. Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial. Indian J Anaesth. 2019 Nov;63(11):895-899. doi: 10.4103/ija.IJA_363_19. Epub 2019 Nov 8. — View Citation

Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018 Oct 12;19(1):369. doi: 10.1186/s12891-018-2276-3. — View Citation

Mian P, Allegaert K, Spriet I, Tibboel D, Petrovic M. Paracetamol in Older People: Towards Evidence-Based Dosing? Drugs Aging. 2018 Jul;35(7):603-624. doi: 10.1007/s40266-018-0559-x. Review. — View Citation

Mubark I, Abouelela A, Genena A, Al Ghunimat A, Sarhan I, Ashwood N. Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff. Cureus. 2020 Sep 30;12(9):e10744. doi: 10.7759/cureus.10744. — View Citation

Oc Y, Varol A, Yazar EA, Ak S, Akpolat AO, Kilinc BE. Treatment strategy for elderly patients with the isolated greater trochanteric fracture. SAGE Open Med. 2020 Oct 7;8:2050312120964138. doi: 10.1177/2050312120964138. eCollection 2020. — View Citation

Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J. Quality of life after hip fracture in the elderly: A systematic literature review. Injury. 2016 Jul;47(7):1369-82. doi: 10.1016/j.injury.2016.04.018. Epub 2016 Apr 23. Review. — View Citation

Piscitelli P, Neglia C, Feola M, Rizzo E, Argentiero A, Ascolese M, Rivezzi M, Rao C, Miani A, Distante A, Esposito S, Iolascon G, Tarantino U. Updated incidence and costs of hip fractures in elderly Italian population. Aging Clin Exp Res. 2020 Dec;32(12):2587-2593. doi: 10.1007/s40520-020-01497-0. Epub 2020 Feb 13. — View Citation

Röder F, Schwab M, Aleker T, Mörike K, Thon KP, Klotz U. Proximal femur fracture in older patients--rehabilitation and clinical outcome. Age Ageing. 2003 Jan;32(1):74-80. — View Citation

Rowlands M, Walt GV, Bradley J, Mannings A, Armstrong S, Bedforth N, Moppett IK, Sahota O. Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial. BMJ Open. 2018 Apr 10;8(4):e019650. doi: 10.1136/bmjopen-2017-019650. — View Citation

Soffin EM, Gibbons MM, Wick EC, Kates SL, Cannesson M, Scott MJ, Grant MC, Ko SS, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Hip Fracture Surgery. Anesth Analg. 2019 Jun;128(6):1107-1117. doi: 10.1213/ANE.0000000000003925. Review. — View Citation

Uysal AI, Altiparmak B, Yasar E, Turan M, Canbek U, Yilmaz N, Gümüs Demirbilek S. The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulus Travma Acil Cerrahi Derg. 2020 Jan;26(1):109-114. doi: 10.14744/tjtes.2019.78002. — View Citation

* Note: There are 31 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Pain change of 1 point at visual analogue scale for pain (VAS) after the 1 st hour of treatment (T1). The Visual Analogue Scale for Pain (VAS) is a validated self-reported instrument that identifies pain from 0 to 10 (with 0 = no pain and 10 = maximum pain intensity) Baseline and 1 hour
Secondary Pain change of at least 2 points on the VAS scale at the 4 th hour (T4) identifies pain from 0 to 10 (with 0 = no pain and 10 = maximum pain intensity) Baseline and 4 hours
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