Opioid Use Clinical Trial
Official title:
Randomized Clinical Trial of Non-Opioid Pain Medications After Adenotonsillectomy
Verified date | October 2021 |
Source | University of Pittsburgh |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The goal of this study is to determine if non-opioid pain control is a safe way to manage pain after adenotonsillectomy surgery in children. The investigators will be randomly assigning children aged 3-17 to one of two groups: one group will receive non-opioid pain medication only, and the other group will receive opioid and non-opioid medications for pain control. The investigators will analyze the data and determine if there is a difference in pain control between the two drug regimens, and if there are any other associated complications between the two groups. This study is important because if we can demonstrate that there is little difference in outcomes and pain control between the two groups, a strong argument can be made for reducing or eliminating opioid prescription after adenotonsillectomy. This may protect future children from the risks of taking opioid medications and help to reduce the scope of the opioid epidemic.
Status | Terminated |
Enrollment | 268 |
Est. completion date | May 18, 2020 |
Est. primary completion date | May 18, 2020 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 3 Years to 17 Years |
Eligibility | Inclusion Criteria: • Patients age 3 - 17 undergoing adenotonsillectomy Exclusion Criteria: - Down syndrome - History of coagulopathy - Craniofacial abnormalities - Caregivers who cannot speak, read, or write in English proficiently - Patients who take opioids during the enrollment period - Patients who take chronic opioids - Pregnancy - Allergy to or contraindication for taking any of the study medications - Patients who have the inability to communicate - Patients who have the inability to localize pain |
Country | Name | City | State |
---|---|---|---|
United States | UPMC Children's Hospital of Pittsburgh | Pittsburgh | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
David Chi, MD |
United States,
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Holte K, Kehlet H. Effect of postoperative epidural analgesia on surgical outcome. Minerva Anestesiol. 2002 Apr;68(4):157-61. Review. — View Citation
Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-Tafti S, Reid D, Maclean J, Koren G. Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015 Feb;135(2):307-13. doi: 10.1542/peds.2014-1906. — View Citation
Luk LJ, Mosen D, MacArthur CJ, Grosz AH. Implementation of a Pediatric Posttonsillectomy Pain Protocol in a Large Group Practice. Otolaryngol Head Neck Surg. 2016 Apr;154(4):720-4. doi: 10.1177/0194599815627810. Epub 2016 Feb 16. — View Citation
Monitto CL, Hsu A, Gao S, Vozzo PT, Park PS, Roter D, Yenokyan G, White ED, Kattail D, Edgeworth AE, Vasquenza KJ, Atwater SE, Shay JE, George JA, Vickers BA, Kost-Byerly S, Lee BH, Yaster M. Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge. Anesth Analg. 2017 Dec;125(6):2113-2122. doi: 10.1213/ANE.0000000000002586. — View Citation
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(50-51):1445-1452. doi: 10.15585/mmwr.mm655051e1. — View Citation
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Van Cleve WC, Grigg EB. Variability in opioid prescribing for children undergoing ambulatory surgery in the United States. J Clin Anesth. 2017 Sep;41:16-20. doi: 10.1016/j.jclinane.2017.05.014. Epub 2017 Jun 3. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Number of Participants With Readmissions | Number of participants with hospitalizations after discharge in 14 days - assessed using the electronic medical record and the take-home pain diary. | 14 days post-operatively | |
Other | Average Dose of Each Analgesic Used | In the take-home pain diary, patients will record the amount of medication taken for each dose. The mean value of these doses will be calculated and averaged within each group to determine the average dose of each analgesic used. | 14 days post-operatively | |
Other | Duration of Each Analgesic Used | Using the results of the take-home pain diary, we will calculate the average number of days of use of each analgesic for each group. The last day after which there is no subsequent use of analgesic will define the end-point of the duration of use. | 14 days post-operatively | |
Other | Mean of Total Quantity of Pain Medications Taken | Using the take-home pain diary, the total amount in mL of each analgesic used over 14 days by each patient in a group will be averaged and reported. | 14 days post-operatively | |
Other | Overall Pain Relief Satisfaction | Score assigned by the patient at the end of 14 post-operative days in the take-home pain diary using a Likert scale. Patients will respond to the following statement "I am happy with the pain relief I received in the last 14 days" with responses ranging from strongly agree to strongly disagree. The responses will be assigned a numerical value, from 0 (strongly disagree) to 4 (strongly agree), and the average value for all subjects in the group will be reported as the overall pain relief satisfaction. Higher scores mean a better outcome. | 14 days post-operatively | |
Other | Post-operative Nursing Phone Calls | Number of post-operative phone calls to nursing staff, obtained using the electronic medical record. | 14 days post-operatively | |
Other | Number of Night-time Awakenings | Number of night-time awakenings reported in 14 days - assessed via the take-home pain diary. | 14 days post-operatively | |
Other | Non-opioid Group Switching to Opioid Group | Number of non-opioid group members switching to receiving opioid medication - assessed via the take-home pain diary. | 14 days post-operatively | |
Other | Need for Follow-up Appointment | Does the parent/guardian believe his/her child would require a follow-up appointment - assessed using the individual pain diary. | two months post-operatively | |
Other | Household Income | Total household income ranges will be assessed in the take-home pain diary and reported. | 14 days post-operatively | |
Other | Education Level | Using the take-home pain diary, parents/guardians of the patients will identify the highest level of education achieved by anyone in the household. | 14 days post-operatively | |
Primary | Average Pain Burden | Average pain over 14 post-operative days before and after medications. This is quantified using the validated Wong-Baker FACES pain metric. Patients receive a take-home pain diary and for 14 days report their maximum pain both before and after taking pain medication. The mean of these pain ratings will be the primary outcome measure. The Wong-Baker FACES scale is from 0 (min) to 10 (max). A higher score indicates worse outcome/pain. | 14 days post-operatively | |
Secondary | Number of Participants With ED (Emergency Department) or Urgent Care Visits | Number of participants with emergency department or urgent care visits in 14 post-operative days - assessed via the electronic medical record and the take-home pain diary. | 14 days post-operatively | |
Secondary | Number of Side Effects of Medications | Number of any of the following side effects experienced: Nausea, vomiting, constipation, stomach ache, difficulty breathing. Assessed at follow-up and take-home pain diary. | 14 days post-operatively |
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