- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03052816
Ice T Postoperative Multimodal Pain Regimen in FPMRS Surgery (ICET)
ICE-T Postoperative Multimodal Pain Regimen Compared to the Standard Regimen in Same Day Vaginal Pelvic Reconstructive Surgery: a Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Pelvic floor disorders involve a myriad of complicated, interwoven clinical conditions that involve pelvic organ prolapse, urinary incontinence, fecal incontinence, and other pathology involving the genital and lower urinary tract. It is estimated that pelvic floor disorders affect up to 25% of all adult women in the United States with increasing prevalence with age. By the age of sixty, 1 in 9 women will undergo surgical intervention for pelvic organ prolapse and/or incontinence, increasing to 1 in 5 by the age of 80. As the population in the United States ages, the demand for healthcare for pelvic floor disorders is estimated to increase up to 40% in the next 30 years.
Despite the prevalence of surgery performed for pelvic floor disorders, there is a paucity of data on postoperative pain control that is dedicated to female pelvic reconstructive surgery. In a recent review, there was only one study that evaluated postoperative pain control after vaginal reconstructive surgery, and the mainstay of therapy was opioid driven. Generally, postoperative pain control in gynecologic surgery has been opioid driven, frequently involving multiple narcotics for analgesia, resulting opioid related complications, including nausea, vomiting, constipation, urinary retention, and central nervous system side effects In an effort to combat opioid use in gynecologic and female pelvic reconstructive surgery, multimodal therapy has been gaining momentum with goals of improved pain control and decreased opioid requirements. Ice packs, toradol, and acetaminophen have been used in various trials to decrease postoperative opioid requirements in various surgeries.
Ice packs have been shown to be effective in the treatment of postoperative pain after abdominal midline incisions. A Cochrane Review of patients subject to post vaginal delivery perineal cooling included 10 randomized controlled trials with1825 patients with some evidence that local cooling in the form of ice packs, cold gel packs, cold/ice backs may be effective in pain relief.
Toradol has been extensively studied in a multitude of surgeries including spinal, obstetric, orthopedic, urologic, and gynecologic. It has been administered preemptively, intraoperatively, and postoperatively for pain control with evidence that toradol decreases postoperative subjective pain scores and decreased narcotic use.
Acetaminophen is mainstay for postoperative pain control as part of multimodal pain regimens to complement other, opioid sparing medications in a multitude of surgeries including abdominal hysterectomy.
Therefore, the purpose of this randomized controlled study is to determine whether, "ICE-T" a novel multimodal postoperative pain regimen composed of around the clock ice packs, toradol, and tylenol, has improved pain control and decrease opioid intake compared to the standard postoperative pain regimen in patients undergoing vaginal pelvic floor reconstructive surgery.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Ohio
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Cleveland, Ohio, United States, 44106
- University Hospitals Case Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- The inclusion criteria are the following:
- Consenting, English speaking women between ages 18 and 80 who will undergo same day vaginal female pelvic reconstructive surgery at MetroHealth Medical Center
- Ability to read VAS Scores
Specific vaginal procedures include, but are not limited to:
- Periurethral bulking
- Perineoplasty
- Complete vaginectomy
- Le Forte colpocleisis
- Anterior repair
- Posterior repair
- Enterocele repair
- Anterior and posterior repair
- Anterior, posterior and enterocele repair
- Transvaginal mesh use
- Sacrospinous ligament fixation
- Uterosacral ligament suspension
- Vaginal paravaginal defect repair
- Midurethral Sling
- Sphincteroplasty
- Vaginal hysterectomy, for uterus 250 g or less
- Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)
- Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele
- Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele
- Vaginal hysterectomy, for uterus greater than 250 g
- Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
- Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele
- Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele
Exclusion Criteria:
- The exclusion criteria are the following:
- History of chronic pelvic pain
- Abdominal surgery
- Laparoscopic surgery
- History of psychiatric disease
- Currently taking analgesic medications
- Currently taking sedatives
- Liver disease
- Renal disease with CrCl < 60cc/min.
- History of burns from application of ice.
- Women who did not consent for the study.
- Intraoperative concern for increased blood loss
- Unable to speak English
- Unable to understand VAS Scores
- Undergoing concomitant abdominal or laparoscopic procedures.
- Allergy to motrin, toradol, Percocet, Tylenol
- Active or history of peptic ulcer disease
- History of GI bleeding or perforation
- Hemorrhagic diathesis
- Severe uncontrolled heart failure
- Inflammatory bowel disease
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ICE T
|
Ice/Tylenol/Toradol with dilaudid for breakthrough
|
Active Comparator: Standard
|
Standard regimen
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual Analog Scores (VAS)
Time Frame: Visual Analog Scores (VAS) Score in the morning of post op day 1 at 7am.
|
Visual Analog Scores (VAS) Scores in the morning of post op day 1.
The VAS is a 100mm scale with a score of no pain on the left of the scale, indicating a score of 0, and a score of worst pain on the right, indicating a score of 10.
Patient is instructed to score the scale where they feel is appropriate.
Each demarcation in between marks is 10mm and after the patient marks their score it is measured using mm from 0mm-100mm.
A score of 0 is 0mm and a score of 10 is 100mm.
|
Visual Analog Scores (VAS) Score in the morning of post op day 1 at 7am.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
VAS Scores at 4 Hours Post Surgery
Time Frame: VAS Scores at 4 hours post surgery
|
VAS Scores at 4 hours post surgery.
The VAS is a 100mm scale with a score of no pain on the left of the scale, indicating a score of 0, and a score of worst pain on the right, indicating a score of 10.
Patient is instructed to score the scale where they feel is appropriate.
Each demarcation in between marks is 10mm and after the patient marks their score it is measured using mm from 0mm-100mm.
A score of 0 is 0mm and a score of 10 is 100mm.
|
VAS Scores at 4 hours post surgery
|
VAS Scores 96 Hours After Surgery
Time Frame: VAS Scores 96 hours after surgery
|
VAS Scores 96 hours after surgery.
The VAS is a 100mm scale with a score of no pain on the left of the scale, indicating a score of 0, and a score of worst pain on the right, indicating a score of 10.
Patient is instructed to score the scale where they feel is appropriate.
Each demarcation in between marks is 10mm and after the patient marks their score it is measured using mm from 0mm-100mm.
A score of 0 is 0mm and a score of 10 is 100mm.
|
VAS Scores 96 hours after surgery
|
Quality of Recovery Scores on Post op Day 1
Time Frame: Quality of Recovery scores on post op day 1
|
Quality of Recovery scores on post op day 1.
The QoR-40 is a 40-item quality of recovery score measuring 5 dimensions: physical comfort (12 items), emotional state (9 items), physical independence (5 items), psychological support (7 items), and pain (7 items).
Each item is rated on a 5-point Likert scale.
The QoR-40 has a possible score of 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery).
It was specifically designed to measure a patient's health status after surgery and anesthesia, and it has been proposed as a measure of outcome in clinical trials.
|
Quality of Recovery scores on post op day 1
|
Satisfaction Scores in the Morning After Surgery (7AM)
Time Frame: Satisfaction scores in the morning after surgery (7AM)
|
Satisfaction scores in the morning after surgery (7AM).
The satisfaction score is a numerical score from 0-10 with a score of 0 indicating very dissatisfied on the left of the scale and 10 indicating very satisfied on the right of the scale.
|
Satisfaction scores in the morning after surgery (7AM)
|
Satisfaction Scores 96 Hours After Surgery
Time Frame: Satisfaction scores 96 hours after surgery
|
Satisfaction scores 96 hours after surgery.
The satisfaction score is a numerical score from 0-10 with a score of 0 indicating very dissatisfied on the left of the scale and 10 indicating very satisfied on the right of the scale.
|
Satisfaction scores 96 hours after surgery
|
Length of Stay
Time Frame: Time from end of surgery to discharge home from hospital, assessed up to 1 week.
|
Length of time from the end of surgery to discharge home from the hospital, assessed up to 1 week.
|
Time from end of surgery to discharge home from hospital, assessed up to 1 week.
|
Total Dose of Opioids Administered During Hospitalization
Time Frame: Total dose of opioids administered during hospitalization in morphine equivalents from the end of surgery to discharge up to 1 week
|
Total dose of opioids administered during hospitalization in morphine equivalents upon hospital discharge.
|
Total dose of opioids administered during hospitalization in morphine equivalents from the end of surgery to discharge up to 1 week
|
Postoperative Nausea and Vomiting at 7AM After Surgery
Time Frame: Postoperative nausea and vomiting from the time to end of surgery until 7AM after surgery
|
Number of patients with postoperative nausea and vomiting at 7AM after surgery
|
Postoperative nausea and vomiting from the time to end of surgery until 7AM after surgery
|
Number of Participants With Urinary Retention.
Time Frame: Number of participants with urinary retention (discharge home with foley) measured on day patient is discharged home/study completion up to 1 week.
|
Number of participants with urinary retention (discharge home with foley)
|
Number of participants with urinary retention (discharge home with foley) measured on day patient is discharged home/study completion up to 1 week.
|
Collaborators and Investigators
Publications and helpful links
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 (Actual)
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
- Pathological Conditions, Anatomical
- Pain, Postoperative
- Prolapse
- Pelvic Organ Prolapse
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Opioid
- Narcotics
- Hydromorphone
Other Study ID Numbers
- 16-00498
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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