- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01784991
Study of Respiratory Depression When Using a Hydromorphone Pain Protocol
March 6, 2020 updated by: Albert Einstein Healthcare Network
"Does a 1 Plus 1 Hydromorphone Pain Protocol Have a Similar Rate of Respiratory Depression to Physician Discretion Protocol in a Geriatric Population With Moderate to Severe Pain?"
This is a study about the efficiency and safety of a 1mg+1mg hydromorphone pain management protocol for the treatment of moderate to sever pain in the Emergency Department.
Appropriate patients 60 years and older who present with a condition that causes moderate to severe pain, according to the attending physician's judgment, in which the physician would order the use of parenteral analgesia will be enrolled in one of two study arms, "1+1" versus usual care group.
1+1 patients will receive 1mg hydromorphone followed by another 1mg after 15 minutes if pain persists.
Usual care group patients will have pain treated per the discretion of the attending physician.
Respiratory status, vital signs, and pain scores will be monitor to assess the efficiency of pain control as well as the safety of pain medicine administration in terms of respiratory depression.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
This is a study about the efficiency and safety of a 1mg+1mg hydromorphone pain management protocol for the treatment of long bone fractures in the Emergency Department.
Appropriate patients 60 years and older who present with a condition that causes moderate to severe pain, according to the attending physician's judgment, in which the physician would order the use of parenteral analgesia will be screened and randomized to one of two study arms, "1+1" versus usual care group.
Neither the research associate, nurse, or attending physician will be blinded to the patients randomization.
Patient pain score will be assessed at baseline using VAS score.
"1+1" patients will receive 1mg hydromorphone at "timepoint 0" (baseline) followed by another 1mg after 15 minutes (along with repeat VAS pain score) if the patient answers "yes" to "Do you need more pain medicine?"
At 60 minutes, patient pain will be assessed a final time and if patient needs more pain medicine, additional treatment will be dictated by physician discretion.
Usual care group patients will also have VAS pain scores assessed at timepoint 0, 15 and 60 minutes and will have pain treated per the discretion of the attending physician.
Patients will be placed on capnometer for continuous monitoring of respiratory status to guard against any opioid induced respiratory depression.
Respiratory status, vital signs, and pain scores will be monitor to assess the efficiency of pain control as well as the safety of pain medicine administration in terms of respiratory depression.
We propose that the "1+1" hydromorphone protocol is easy to implement, as it includes a set timeline, a standard question, and a set dosage of a potent analgesic.
We hypothesize that it will provide adequate analgesia in the majority of patients without causing the anticipated level of respiratory depression.
Study Type
Interventional
Enrollment (Actual)
116
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19141
- Albert Einstein Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
60 years to 90 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Any patient who presents a condition that causes moderate to severe pain, according to the attending physician's judgment, in which the physician would order the use of parenteral analgesia
- Able to provide consent.
Exclusion Criteria:
- Patient or family member unable to consent
- Altered mental status
- SpO2 less than 95 percent
- Allergy to opiates
- Hypotension (Systolic blood pressure less than 90 mmHg)
- Chronic oxygen dependency or known CO2 retention
- Acute ETOH or drug intoxication
- History of chronic pain syndrome or chronic use of opiate narcotics
- History of opiate/heroin addiction, past or current.
- End stage renal disease/dialysis patient
- Chronic metabolic acidosis
- Physician feels that patient would be poor candidate for study
- Weight less than 100 pounds, all patients will be weighted
- Patients younger than 60 years of age
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 1mg + 1mg Hydromorphone
Patient will receive 1 mg of hydromorphone for pain at timepoint 0. After 15 minutes, patients will be asked if the still need pain medication.
If yes, patients will immediately receive 1mg hydromorphone.
Patients will be under continuous monitoring for respiratory depression via capnometer.
At 60 minutes, pain will be re-assessed for a second time.
If needed, physician will give additional pain meds per their discretion.
|
1mg of Hydromorphone at timepoint 0 and 1 mg of hydromorphone at 15 min timepoint.
Other Names:
|
Active Comparator: Usual Care Group
Patient will receive pain medicine per doctor's discretion at timepoint 0. After 15 minutes, patients will be asked if they still need pain medication.
If yes, physicians will not be notified and patient will continue to have pain managed as deemed necessary by physician per "usual care."
Patients will be under continuous monitoring for respiratory depression via capnometer.
At 60 minutes, pain will be re-assessed for a second time.
If needed, physician will give additional pain meds per their discretion.
|
Patient will have pain treated at timepoint 0 as per usual care based on physician discretion.
At 15 min timepoint, patients will be asked for pain level, and then subsequently treated as per physician discretion.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Respiratory Depression
Time Frame: From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Incidence of respiratory depression (defined as a ETCO2 of 50 mmHg or greater, a 10% change from baseline, or loss of waveform for 15 seconds or greater)
|
From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Successful Treatment of Patient Pain
Time Frame: 15 min and 60 min after baseline
|
Defined as: Declining additional pain medication at 15 minutes or requesting additional pain medication at 15 min, but declining at 60 minutes
|
15 min and 60 min after baseline
|
Change in VAS Score
Time Frame: 15 min and 60 min after baseline
|
A 13 mm change or greater on a VAS score
|
15 min and 60 min after baseline
|
Hypoxia
Time Frame: From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Defined as SpO2 of 93% or less for 15 seconds
|
From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Hypotension
Time Frame: Every 5 minutes from administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Hypotension defined as systolic blood pressure less than 90 mmHg
|
Every 5 minutes from administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Allergic Reaction to Study Drug
Time Frame: From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
|
Serious Adverse Events
Time Frame: From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Defined as prolonged hypoxia, need for positive pressure ventilation or intubation, hospital admission secondary to study drug.
|
From administration of drug (time 0 minutes) to end of study (60 minute mark)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
December 1, 2011
Primary Completion (Actual)
April 16, 2014
Study Completion (Actual)
April 16, 2014
Study Registration Dates
First Submitted
June 25, 2012
First Submitted That Met QC Criteria
February 5, 2013
First Posted (Estimate)
February 6, 2013
Study Record Updates
Last Update Posted (Actual)
March 19, 2020
Last Update Submitted That Met QC Criteria
March 6, 2020
Last Verified
December 1, 2016
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Respiratory Tract Diseases
- Mood Disorders
- Respiration Disorders
- Depression
- Depressive Disorder
- Respiratory Insufficiency
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Opioid
- Narcotics
- Morphine
- Hydromorphone
Other Study ID Numbers
- HN - 4325
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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