- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02107339
Methadone and Hydromorphone For Spinal Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Patients: 100 patients (ages 18-80) will be enrolled in this clinical trial. All patients presenting for elective posterior lumbar or thoracic spinal fusion surgery will be eligible for enrollment. Patients will be randomized to receive either methadone or hydromorphone on the basis of a computer generated random number table. Patients in each group will receive standard clinical intraoperative doses of either methadone (0.2 mg/kg) or hydromorphone (2 mg). An analysis of patients undergoing posterior lumbar fusion surgery at Evanston Hospital revealed that patients received, on average, approximately 2 mg of hydromorphone intraoperatively. The most commonly used doses of methadone administered in clinical studies have been either 0.2 mg/kg or a dose of 20 mg. Furthermore, these doses also represent dosages which appear to be approximately equipotent. Study medications will be prepared by the pharmacy, and all clinicians will be blinded to group assignment. Two syringes will be prepared for each patient, one which contains the study drug (either methadone 0.2 mg/kg or hydromorphone 2 mg), and the other containing the placebo (saline). If the patient is randomized to the methadone group, a 3 cc syringe containing 0.2 mg/kg of methadone and saline (total volume 3 cc) will be prepared, as well as a 10 cc syringe containing 10 cc of saline (placebo). If the patient is randomized to the hydromorphone group, a 3 cc syringe containing 3 cc of saline (placebo) will be prepared, as well as a 10 cc syringe containing 2 mg of hydromorphone with 9 cc of saline (total volume 10 cc). At induction of anesthesia, the 3 cc syringe containing either 0.2 mg/kg of methadone or placebo will be given over 5 seconds. At the conclusion of surgery, the 10 cc syringe of either hydromorphone or placebo will be titrated slowly per clinician's preference. The administration of all other anesthetic agents will be standardized and reflect the usual practices of anesthesiologists at Evanston Hospital (spine protocol).
Anesthesia will be standardized and include propofol for induction, a propofol and remifentanil infusion for maintenance (plus sevoflurane), and IV acetaminophen 1000 mg during the last 60 minutes of the case.
On arrival to the postanesthesia care unit (PACU), patients will be assessed for pain by PACU nurses per standard protocols. Patients will be evaluated for pain on PACU arrival and then every 15 minutes. Patients will be administered hydromorphone 0.25-0.5 mg for pain, and doses will be repeated until the patient is comfortable (pain < 3 on a scale of 0-10; 0=no pain and 10=worst pain imaginable). The patient will then be connected to a PCA device to deliver pain medication during the remainder of the postoperative period.
All postoperative management will be per standard surgical protocols
Sample Size: The primary end-point of the investigation is amount of hydromorphone used. In a clinical trial by Urban et al. of patients undergoing complex spine surgery using a standard anesthetic, average hydromorphone consumption in the first 24 hours was 27 mg (18). The investigators expect to see at least a 33% reduction in hydromorphone consumption in the methadone group. Group sample sizes of 39 and 39 achieve 91% power to detect a difference of 9.0 between the null hypothesis that both group means are 27.0 and the alternative hypothesis that the mean of group 2 is 18.0 with estimated group standard deviations of 10.0 and 10.0 and with a significance level (alpha) of 0.01000 using a two-sided two-sample t-test. The investigators plan to enroll a total of 100 patients to ensure complete collection of data.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Illinois
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Evanston, Illinois, United States, 60201
- NorthShore University HealthSystem
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All patients presenting for elective posterior lumbar or thoracic spinal fusion surgery will be eligible for enrollment.
Exclusion Criteria:
- Preoperative renal failure (defined as a serum creatinine > 2.0 mg/dL.)
- American Society of Anesthesiologists Physical Status IV or V
- Pulmonary disease necessitating home oxygen therapy
- Allergy to methadone or hydromorphone
- Preoperative recent history of opioid or alcohol abuse
- Inability to use a PCA device or speak the English language
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: methadone group
Patient will receive methadone 0.2 mg/kg at induction of anesthesia (single dose)
|
Methadone 0.2 mg/kg administered at induction of anesthesia
|
Active Comparator: Hydromorphone group
Patients will receive hydromorphone 2 mg at the end of the surgical procedure
|
Hydromorphone 2 mg administered at the conclusion of anesthesia
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Hydromorphone Use at 24 Hours
Time Frame: Use of hydromorphone at 24 hours
|
Use of hydromorphone at 24 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hydromorphone Use Second 24 Hours
Time Frame: 24-48 hours after surgery
|
24-48 hours after surgery
|
|
Hydromorphone Use Third 24 Hours
Time Frame: 48-72 hours after surgery
|
48-72 hours after surgery
|
|
Pain Scores Postanesthesia Care Unit (PACU) Arrival
Time Frame: First 5 minutes after PACU arrival
|
11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
First 5 minutes after PACU arrival
|
Pain Scores 1 Hour After PACU Arrival
Time Frame: Pain scores at 60 minutes after PACU admission
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11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
Pain scores at 60 minutes after PACU admission
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Pain Scores 2 Hours After PACU Arrival
Time Frame: Pain scores at 120 minutes after PACU admission
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11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
Pain scores at 120 minutes after PACU admission
|
Pain Scores on Postoperative Day One
Time Frame: Pain scores one day after PACU admission
|
11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
Pain scores one day after PACU admission
|
Pain Scores on Postoperative Day 2
Time Frame: Pain scores 48 hours after PACU admission
|
11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
Pain scores 48 hours after PACU admission
|
Pain Scores Postoperative Day 3
Time Frame: Pain scores 72 hours after PACU admission
|
11-point verbal rating scale (0=no pain, 10=worst pain imaginable)
|
Pain scores 72 hours after PACU admission
|
Patient Satisfaction Scores
Time Frame: Postopertive day 1
|
Patient satisfaction with overall pain management will be determined using a 101-point verbal rating scale (0=highly dissatisfied (worst), 100=highly satisfied (best))
|
Postopertive day 1
|
Patient Satisfaction Scores
Time Frame: postoperative day 2
|
Patient satisfaction with overall pain management will be determined using a 101-point verbal rating scale (0=highly dissatisfied (worst), 100=highly satisfied (best))
|
postoperative day 2
|
Patient Satisfaction Scores
Time Frame: Postoperative day 3
|
Patient satisfaction with overall pain management will be determined using a 101-point verbal rating scale (0=highly dissatisfied (worst), 100=highly satisfied (best))
|
Postoperative day 3
|
Chronic Persistent Surgical Pain-Weekly Frequency of Pain
Time Frame: One month after surgery
|
0=< once per week; 1=once per week; 2=twice per week; 3=daily; 4=constant
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One month after surgery
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Chronic Persistent Surgical Pain-weekly Frequency of Pain
Time Frame: 3 months after surgery
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0=< once per week; 1=once per week; 2=twice per week; 3=daily; 4=constant
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3 months after surgery
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Chronic Persistent Surgical Pain-Weekly Frequency of Pain
Time Frame: 6 months after surgery
|
0=< once per week; 1=once per week; 2=twice per week; 3=daily; 4=constant
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6 months after surgery
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Chronic Persistent Surgical Pain-Weekly Frequency of Pain
Time Frame: 12 months after surgery
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0=< once per week; 1=once per week; 2=twice per week; 3=daily; 4=constant
|
12 months after surgery
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Postoperative Complications
- Pain
- Neurologic Manifestations
- Pain, Postoperative
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Opioid
- Narcotics
- Respiratory System Agents
- Antitussive Agents
- Hydromorphone
- Methadone
Other Study ID Numbers
- EH14-113
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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