PAracetamol and NSAID in Combination: A Randomised, Blinded, Parallel, 4-group Clinical Trial

Pain, Postoperative Clinical Trial

— PANSAID  

Official title:

PAracetamol and NSAID in Combination: A Randomised, Blinded, Parallel, 4-group Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02571361
• Other study ID #: SM2-KHT-2015 - v2
• Secondary ID: 2015-002239-16
• Status: Completed
• Phase: Phase 4
• First received: October 7, 2015
• Last updated: February 9, 2018
• Start date: November 2015
• Est. completion date: January 2018

Study information

• Verified date: February 2018
• Source: Naestved Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Trial name: PAracetamol and NSAID in combination: A randomised, blinded, parallel, 4-group clinical trial

Trial acronym: PANSAID

Background: Effective postoperative pain management is essential for the well-being and rehabilitation of the surgical patient. No "gold standard" exists after total hip arthroplasty (THA) and combinations of different non-opioid medications are used with virtually no evidence for additional analgesic efficacy compared to monotherapy.

Objectives: The objective of this trial is to investigate the analgesic effects and safety of paracetamol and ibuprofen and their combination in different dosages after THA.

Intervention: Patients are randomised to 4 groups: A) paracetamol 1 g x 4 and ibuprofen 400 mg x 4; B) paracetamol 1 g x 4 and placebo (ibuprofen); C) placebo (paracetamol) and ibuprofen 400 mg x 4; and D) paracetamol 0,5 g x 4 and ibuprofen 200 mg.

Design: Placebo controlled, parallel 4-group, multicentre trial with adequate centralised computer-generated allocation sequence and allocation concealment with varying block size and stratification by site. Blinding of assessor, investigator, caregivers, patients, and statisticians.

Sample size: 556 eligible patients are needed to detect a difference of 10 mg morphine the first postoperative day with a standard deviation of 20 mg and a type 1 error rate of 0,004 (two-sided) and a type 2 error rate of 0,10.

Description:

Trial name: PAracetamol and NSAID in combination: A randomised, blinded, parallel, 4-group clinical trial

Trial acronym: PANSAID

Background: Effective postoperative pain management is essential for the well-being and rehabilitation of the surgical patient. No "gold standard" exists after total hip arthroplasty (THA) and combinations of different non-opioid medications are used with virtually no evidence for additional analgesic efficacy compared to monotherapy.

Objectives: The objective of this trial is to investigate the analgesic effects and safety of paracetamol and ibuprofen and their combination in different dosages after THA.

Intervention: Patients are randomised to 4 groups: A) paracetamol 1 g x 4 and ibuprofen 400 mg x 4; B) paracetamol 1 g x 4 and placebo (ibuprofen); C) placebo (paracetamol) and ibuprofen 400 mg x 4; and D) paracetamol 0,5 g x 4 and ibuprofen 200 mg.

Design: Placebo controlled, parallel 4-group, multicentre trial with adequate centralised computer-generated allocation sequence and allocation concealment with varying block size and stratification by site. Blinding of assessor, investigator, caregivers, patients, and statisticians.

Sample size: 556 eligible patients are needed to detect a difference of 10 mg morphine the first postoperative day with a standard deviation of 20 mg and a type 1 error rate of 0,004 (two-sided) and a type 2 error rate of 0,10.

Sub-studies: We preplan the following sub-studies. :

1. A subgroup analysis of benefit outcomes (pain and opioid consumption) with respect to the following sub-groups: sex, age (below vs above 65 years old), ASA-score (I+II vs III), Use of analgesic medication before surgery (none vs any) and anaesthetic technique (general anaesthesia vs. spinal anaesthesia). Please find a detailed protocol at www.pansaid.dk

2. A subgroup analysis of harm (serious adverse events and adverse events) with respect to the following groups sex, age (below vs above 65 years old), use of NSAIDs before surgery, and ASA-score (I+II vs III). Please find a detailed protocol at www.pansaid.dk

3. Longer follow-up than the specified 90 days (1 year)

4. An analysis of the association between VAS-scores and opioid consumption

5. Time-to-event analyses regarding use of PCA-morphine

6. An analysis of the association between preoperative analgesic use and pain/morphine consumption

7. An analysis of the individual patients: how many will achieve "no worse than mild pain" (NRS<3). Please find a detailed protocol at www.pansaid.dk

More sub-studies may be performed post-hoc and they will be clearly identified as such.

Oversight of amendments and approvals Protocol version 2: Approved 12 August 2015: First approved version of the trial protocol

Protocol version 3: Approved 21 January 2016: Clarification of what happens in case of an SAE and definition of major protocol violations

Protocol version 4: Approved 15 June 2016: Clarification of the primary outcome, clarification that steroids are not permitted in the intervention period, and addition of an exploratory outcome (dizziness)

Protocol version 5: Approved 21 December 2016: Clarification of the exclusion criteria of contraindication to paracetamol and addition of stub-studies

Recruitment information / eligibility

• Status: Completed
• Enrollment: 556
• Est. completion date: January 2018
• Est. primary completion date: October 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Scheduled for unilateral, primary Total Hip Arthroplasty (THA)

• Age > 18

• ASA 1-3.

• BMI > 18 and < 40

• Women in the fertile age must have negative urine HCG pregnancy test

• Patients who gave their written informed consent to participating in the trial after having fully understood the contents of the protocol and restrictions.

Exclusion Criteria:

• Patients who cannot cooperate with the trial.

• Concomitant participation in another trial

• Patients who cannot understand or speak Danish.

• Daily use of strong opioids (tramadol and codein are accepted)

• Patients with allergy to the medicines used in the trial.

• Contraindications against NSAID, for example previous ulcer, heart failure, liver failure, or renal failure (eGRF < 60 ml/kg/1,73m2), known thrombocytopenia (<100 mia/L)

• Patients suffering from alcohol and/or drug abuse - based on the investigator's judgement.

Related Conditions & MeSH terms

• Pain, Postoperative

Intervention

Drug:
• Paracetamol (1g x 4)
Dose of 1 g given in 6 hour intervals the first 24 hours postoperatively
• Ibuprofen (400 mg x 4)
Dose of 400 mg given in 6 hour intervals the first 24 hours postoperatively
• Paracetamol (0,5 g x 4)
Dose of 0,5 g given in 6 hour intervals the first 24 hours postoperatively
• Ibuprofen (200 mg x 4)
Dose of 200 mg given in 6 hour intervals the first 24 hours postoperatively
• Placebo (x4)
Given in 6 hour intervals the first 24 hours postoperatively

Locations

Country	Name	City	State
Denmark	Holbæk Hospital	Holbæk
Denmark	Gildhøj Privathospital	København	Brøndby
Denmark	Køge Hospital	Køge
Denmark	Næstved Hospital	Næstved
Denmark	Nykøbing Falster Hospital	Nykøbing Falster
Denmark	Odense University Hospital (OUH)	Odense

Sponsors (2)

Lead Sponsor	Collaborator
Daniel Hägi-Pedersen	Copenhagen Trial Unit, Center for Clinical Intervention Research

Country where clinical trial is conducted

Denmark, 

References & Publications (1)

Thybo KH, Hägi-Pedersen D, Wetterslev J, Dahl JB, Schrøder HM, Bülow HH, Bjørck JG, Mathiesen O. PANSAID - PAracetamol and NSAID in combination: study protocol for a randomised trial. Trials. 2017 Jan 10;18(1):11. doi: 10.1186/s13063-016-1749-7. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Nausea at 6 hours postoperatively (Verbal rating scale)	Level of nausea at 6 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	6 hours postoperatively
Other	Nausea at 24 hours postoperatively (Verbal rating scale)	Level of nausea at 24 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	24 hours postoperatively
Other	Vomiting the first 24 hours postoperatively	Number of vomiting episodes (0-24 hours) measured in the periods 0-6 and 6-24 hours postoperatively	0-24 hours postoperatively
Other	Anti-emetic treatment the first 24 hours postoperatively	Consumption of ondansetron in the period 0-24 hours postoperatively	0-24 hours postoperatively
Other	Sedation at 6 hours postoperatively (Verbal rating scale)	Level of sedation at 6 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	6 hours postoperatively
Other	Sedation at 24 hours postoperatively (Verbal rating scale)	Level of sedation at 24 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	24 hours postoperatively
Other	Blood loss intraoperatively	Blood loss during the surgical procedure (intraoperatively)	intraoperatively
Other	Days alive and outside hospital within 90 days after surgery.	Days alive and outside hospital within 90 days after surgery.	0-90 days postoperatively
Other	Dizziness at 6 hours postoperatively (Verbal rating scale)	Level of dizziness at 6 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	6 hours postoperatively
Other	Dizziness at 24 hours postoperatively (Verbal rating scale)	Level of dizziness at 24 hours postoperatively. Verbal rating scale: none, mild, moderate or severe	24 hours postoperatively
Primary	Morphine consumption the first 24 hours postoperatively	Total need for morphine administered as BOTH patient controlled analgesia (PCA) for the first 24 hours postoperatively AND supplemental morphine administered at the post-anaesthesia unit the first hour postoperatively. Bolus 2.0 mg; lockout: 10 min	0-24 hours postoperatively
Primary	Serious adverse events	Serious adverse events, including death, within 90 days after surgery defined as SAE (according to ICH-GCP-guidelines) except "prolongation of hospitalisation"	0-90 days postoperatively
Secondary	Pain during movement at 6 hours postoperatively (visual analogue scale)	Pain scores (visual analogue scale (VAS)) with active 30 degrees flexion of the hip at 6 hours postoperatively. No pain = 0; worst imaginable pain = 100	6 hours postoperatively
Secondary	Pain during movement at 24 hours postoperatively (visual analogue scale)	Pain scores (visual analogue scale (VAS)) with active 30 degrees flexion of the hip at 24 hours postoperatively. No pain = 0; worst imaginable pain = 100	24 hours postoperatively
Secondary	Pain at rest at 6 hours postoperatively (visual analogue scale)	Pain scores (visual analogue scale (VAS)) at rest at 6 hours postoperatively. No pain = 0; worst imaginable pain = 100	6 hours postoperatively
Secondary	Pain at rest at 24 hours postoperatively (visual analogue scale)	Pain scores (visual analogue scale (VAS)) at rest at 24 hours postoperatively. No pain = 0; worst imaginable pain = 100	24 hours postoperatively
Secondary	Adverse events	Number of patients with one or more adverse events in the intervention period (0-24 hours)	0-24 hours postoperatively

External Links

•   Trial Website