Comparing Intravenous Hydromorphone to Usual Care

Pain Clinical Trial

Official title: Randomized Clinical Trial Comparing Intravenous Hydromorphone to Usual Care

Status Completed

Clinical Trial Summary

In this randomized controlled trial, 2 mg intravenous (IV) hydromorphone will be more efficacious than usual care (usual care is analgesic management according to the judgment of the attending physician caring for that patient) in emergency department (ED) patients aged 21-64 years. The primary efficacy outcomes are the proportion of patients in each arm who choose to forgo additional pain medication in 30 minutes of entry into the study and the change in numerical rating scale (NRS) pain scores from baseline to 30 minutes post baseline.

Clinical Trial Description

Patients were randomized to the 2 mg IV hydromorphone group or usual care; allocation was generated with www.randomization.com, using sealed opaque envelopes opened in sequential order by the research assistants (RAs) immediately following enrollment. Patients randomly allocated to usual care received an initial dose of IV opioid; the type and dose of which was determined by the treating emergency physician (EP). Patients in the 2 mg hydromorphone group were allocated to receive 2 mg IV hydromorphone, administered slowly over 2 to 3 minutes. All patients were placed on 2 L O2 by nasal cannula. Subjects were blinded to the treatment they were assigned. At 30 minutes, both groups were asked the following scripted question: "Do you want more pain medication?" Patients in either group who answered or otherwise indicated "yes" had their treating attending physician notified, who then decided on further pain management. Those who answered or otherwise indicated "no" did not receive additional analgesic at that time. Attending physicians were thus able to treat patients' pain in any manner they deemed fit once this primary study endpoint was reached. In addition to acquisition of the primary endpoint, patients were also asked to rate their pain on a previously validated and reproducible standard verbal NRS ranging from 0 ("no pain") through 10 ("worst pain possible") at 15, 30, 45, 60, 90, and 120 minutes following administration of the initial opioid dose at time 0. For safety reasons, patients were monitored for a total of 120 minutes (i.e., 90 minutes past the primary study endpoint) to determine adverse effects. Systolic blood pressure, heart rate, oxygen saturation, nausea, vomiting, and pruritus were assessed at baseline and at 15, 30, 45, 60, 90, and 120 minutes after initial administration of opioid. Patients who experienced oxygen desaturation (defined as < 95%) were gently aroused if sleeping, asked to take several deep breaths, and repositioned into a sitting position if they had been in a reclined position. Nasal cannula oxygen was also increased to 4 L, and the treating attending physician was notified. Subsequent management, including the use of naloxone, was per the treating attending physician's discretion. ;

Related Conditions & MeSH terms

• Pain

• NCT number: NCT01429298
• Study type: Interventional
• Source: Montefiore Medical Center
• Status: Completed
• Phase: Phase 4
• Start date: March 2010
• Completion date: November 2010