Postoperative Pain Relieve for Patients Undergoing Surgical Treatment of Femoral Fracture
Risk-benefit Analysis of Intrathecal Morphine Administration to Patients Undergoing Surgical Treatment of Proximal Femoral Fracture (Monocentric, Single-blinded, Randomized Clinical Study Compared to Standard Treatment)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Jiří Hynčica
- Phone Number: 2587 0042059737
- Email: jiri.hyncica@fno.cz
Study Locations
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-
Moravian-Silesian Region
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Ostrava, Moravian-Silesian Region, Czechia, 70852
- University Hospital Ostrava
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- signed informed consent
- 60 to 90 years of age
- surgical treatment of proximal femur fracture
- The American Society of Anesthesiologists (ASA) classification I to III
- spinal anesthesia used for the operation
Exclusion Criteria:
- general anesthesia used for the operation
- allergy to opioids
- high risk of respiratory depression
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Intrathecal morphine administration
Study subjects randomized into this arm will be administered morphine intrathecally in the dose of dose 100 ug.
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Administration of morphine into the spinal canal.
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Active Comparator: Parenteral administration of analgesics
Study subjects randomized into this arm will receive standard postoperative pain management (parenteral administration of analgesics).
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Standard postoperative pain management of analgesics using parenteral route of administration.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Pain assessment
Time Frame: Every 2 hours after the surgery, total of 24 hours
|
Pain intensity will be assessed using the Visual Analogue Scale (VAS10) scale (0-10).
The total value of all measured values will be calculated.
The maximum value observed during the 24 hours will be also recorded.
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Every 2 hours after the surgery, total of 24 hours
|
|
Pain assessment during patient positioning
Time Frame: 24 hours
|
Pain intensity will be assessed using the VAS10 scale (0-10) during the positioning of the patient.
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24 hours
|
|
Time to administration of rescue medication
Time Frame: 24 hours
|
The time to administration of rescue medication (analgesics) will be observed in hours.
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24 hours
|
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Total consumption of opioids on Intensive Care Unit
Time Frame: 24 hours
|
The total consumption of opioids on Intensive Care Unit will be measured in the number of administered doses.
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24 hours
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Hypoventilation - bradypnea
Time Frame: 24 hours
|
The observed parameters of hypoventilation include bradypnea = respiratory rate (RR)<10/min
|
24 hours
|
|
Hypoventilation - other signs of respiratory insufficiency
Time Frame: 24 hours
|
The observed parameters of hypoventilation will include other signs of respiratory insufficiency.
Will be evaluated as 0-no, 1-yes + the need for oxygenotherapy, 2-yes+ the need for antidote or other treatment
|
24 hours
|
|
Hypotension
Time Frame: 24 hours
|
The observed parameters of hypotension will be as follows: systolic blood pressure (SBP) < 90 mmHg and/or mean arterial pressure (MAP) < 60 mmHg and/or decrease of blood pressure (BP) by more than 20-30 % of the initial values.
Evaluation: 0-no, 1-yes, without administration of noradrenaline, 2-yes, with noradrenaline administration.
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24 hours
|
|
Bradycardia
Time Frame: 24 hours
|
The observed parameters of bradycardia will be as follows: heart rate (HR) < 50/min.
Evaluation: 0-no, 1-yes + administration of atropine or ephedrine, 2-yes+ administration of atropine repeatedly or other treatment.
|
24 hours
|
|
Postoperative nausea and vomiting
Time Frame: 24 hours
|
The incidence of postoperative and vomiting will be observed.
Evaluation: 0-no, 1-nausea, 2-vomiting
|
24 hours
|
|
Effect of antiemetics
Time Frame: 24 hours
|
The effect of antiemetics will be observed.
Evaluation: 0-not administered, 1-administered, 2-no effect
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24 hours
|
|
Pruritus
Time Frame: 24 hours
|
The presence and condition of pruritus will be observed.
Evaluation: 0-no, 1-yes, no scratching, 2-moderate, need of scratching, 3-strong, need of treatment.
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24 hours
|
|
Effect of pruritus treatment
Time Frame: 24 hours
|
The effect of pruritus treatment will be observed.
Evaluation: 0-no medication administered, 1-administered, 2-no effect
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24 hours
|
|
Hypoventilation - presence of hypopnea (TV < 4)
Time Frame: 24 hours
|
The observed parameters of hypoventilation will include hypopnea = Tidal Volume (TV) < 4 ml/min.
It is a physiological parameter that fluctuates depending on the load in the range of 6-180 liters/min.
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24 hours
|
|
Hypoventilation - SpO2
Time Frame: 24 hours
|
The observed parameters of hypoventilation will include inability to maintain oxygen saturation (SpO2) above 90 % without the need for oxygenotherapy.
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24 hours
|
|
Hypoventilation - presence of hypoxemia (paO2) (below 10 kPa)
Time Frame: 24 hours
|
The observed parameters of hypoventilation will include hypoxemia according to the analysis of blood gasses.
Hypoxemia is diagnosed when the partial pressure of oxygen in the arterial blood (paO2) falls below 10 kiloPascals (kPa).
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24 hours
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Denis Buršík, MD, University Hospital Ostrava
Publications and helpful links
General Publications
- Rathmell JP, Pino CA, Taylor R, Patrin T, Viani BA. Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg. 2003 Nov;97(5):1452-1457. doi: 10.1213/01.ANE.0000083374.44039.9E.
- Yamashita K, Fukusaki M, Ando Y, Tanabe T, Terao Y, Sumikawa K. Postoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients. J Anesth. 2009;23(4):504-7. doi: 10.1007/s00540-009-0817-5. Epub 2009 Nov 18.
- Kwan AS, Lee BB, Brake T. Intrathecal morphine for post-operative analgesia in patients with fractured hips. Hong Kong Med J. 1997 Sep;3(3):250-255.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Wounds and Injuries
- Leg Injuries
- Fractures, Bone
- Femoral Fractures
- Hip Injuries
- Hip Fractures
- Femoral Neck Fractures
- Proximal Femoral Fractures
- Physiological Effects of Drugs
- Peripheral Nervous System Agents
- Central Nervous System Depressants
- Sensory System Agents
- Analgesics, Opioid
- Narcotics
- Morphine
- Analgesics
Other Study ID Numbers
Other Study ID Numbers
- FNO-KARIM2021-1
- 2021-002765-17 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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