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Effect of Intravenous Acetaminophen on Postoperative Opioid-related Complications

25. marts 2021 opdateret af: Alparslan Turan, The Cleveland Clinic

Some patients have respiratory depression (decreased breaths per minute) after surgery. Acetaminophen, an FDA approved pain medication, may prevent this problem. The purpose of this study is to determine if acetaminophen decreases respiratory depression after surgery. The investigators will also evaluate the cost effectiveness of acetaminophen.

Patients having elective major abdominal surgery are being asked to participate in this research study. If eligible, a patient will have their baseline tidal volume (amount of air moved into or out of the lungs) and vital capacity (how much air the lungs are capable of holding) measured using a spirometer (apparatus for measuring the volume of air inspired and expired by the lungs) measured before surgery. Three questionnaires will also need to be completed before surgery.

The patient will then be randomized, like flipping a coin, to receive either Acetaminophen or placebo (inactive substance) as an infusion throughout surgery and for the first two days thereafter. Neither the patient nor his or her physician will know if the patient is assigned to study drug or placebo. Regardless of study assignment, both groups will receive standard pain management medications and sedation.

After surgery, the patient's blood pressure, activity, posture, respiratory rate, the electrical activity of the heart, oxygen saturation, tidal volume, minute ventilation and respiratory rate will be continuously monitored and recorded for 48 hours using a wireless pulse-oximeter and a respiratory volume monitor.

48 hours after surgery the patient will be asked to complete a patient satisfaction questionnaire, which will allow the patient to rate the satisfaction with the treatment received for pain. The patient will also be asked to complete a questionnaire about recovery.

At discharge, the patient will be given two questionnaires about pain and quality of life.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

580

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Ohio
      • Cleveland, Ohio, Forenede Stater, 44195
        • Cleveland Clinic Foundation

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 85 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ja

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Written informed consent
  • 18-85 years old
  • above 50 kg
  • American Society of Anaesthesiologists Physical Status 1-3
  • Scheduled for elective open or laparoscopic abdominal surgery, including colorectal, prostate, and hysterectomy surgeries
  • Patients with anticipated hospitalization of two nights
  • Expected to require parenteral opioids for at least 48 hours for postoperative pain
  • Able to use IV Patient-Controlled Analgesia systems

Exclusion Criteria:

  • Hepatic disease, e.g. twice the normal levels of liver enzymes
  • Kidney disease, e.g. twice the normal level of serum creatinine
  • Epidural analgesia or regional blocks (including Transverse abdominis plane block)
  • Acetaminophen sensitivity or known allergy
  • Female patients who are pregnant or breastfeeding
  • Patients taking warfarin

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Intravenous 0.9% sodium chloride
0.9% sodium chloride infusion will be initiated before the surgical incision with 100 ml and repeated every 6 hours for the earlier of 48 postoperative hours of hospital discharge.
Medicin: Intravenous Acetaminophen
Eksperimentel: Intravenous Acetaminophen
Acetaminophen infusion will be initiated before the surgical incision with 1 g and repeated every 6 hours for the earlier of 48 postoperative hours of hospital discharge.
Medicin: Intravenous Acetaminophen

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Duration of Hypoxemia
Tidsramme: the initial 48 hours of postoperative monitoring or for the duration of hospitalization, if shorter.
Hypoxemia is measured as minutes with hypoxemia (Spo2 <90%) per hour of successful Spo2 monitoring. Patients will have nearly continuous pulseoximeter monitoring and recording. Data from the monitor will be downloaded daily for 48 hours postoperatively.
the initial 48 hours of postoperative monitoring or for the duration of hospitalization, if shorter.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Time-weighted Pain Score During Initial 48 Postoperative Hours
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Pain scores were calculated on a visual analog scale of 0 to 10, with 0 being no pain and 10 being the most pain imaginable; time weighted mean was calculated as the area under the curve of the pain score measurements divided by total measurement time. Pain was recorded at roughly 15-minute intervals in the postanesthesia care unit and at 4-hour intervals on surgical wards
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Time Weighted Pain Score in Post Anesthesia Care Unit
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Pain scores were calculated on a visual analog scale of 0 to 10, with 0 being no pain and 10 being the most pain imaginable; time-weighted mean was calculated as the area under the curve of the pain score measurements divided by total measurement time.
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Fatigue Score on Morning of Postoperative Day 1
Tidsramme: Postoperative day 1
Fatigue scores were calculated on a scale of 1 to 10, with 1 being no fatigue and 10 being the worst fatigue imaginable.
Postoperative day 1
Lowest RASS Score During Initial 48 Postoperative Hours
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Sedation was estimated by the RASS score and recorded at 2-hour intervals by ward nurses per clinical routine during the initial 48 postoperative hours. The Richmond Agitation-Sedation Scale (RASS) is scored from -5 to +4, with -5 being unarousable, 0 being alert and calm, and +4 being combative.
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Time Spent in Sitting or Upright Position
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Treatment effect data are reported as ratios of geometric means
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Opioid Consumption - Intravenous Morphine Equivalents
Tidsramme: Initial 48 postoperative hours
Total opioid consumption over the initial 48 postoperative hours was extracted from patients' medical records and converted to intravenous morphine equivalents
Initial 48 postoperative hours
Incidence of Postoperative Nausea and Vomiting
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Patients were asked about postoperative nausea and vomiting in the postanesthesia care unit, at 4-hour intervals while awake through the remaining initial day of surgery, and on the first and second postoperative mornings.
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Incidence of Low Respiratory Function Event
Tidsramme: Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
A low respiratory function event was defined as an episode of less than 40% of predicted minute ventilation for 2 minutes.
Initial 48 postoperative hours or duration of hospitalization (whichever comes first)
Total Anesthetic Dose From Induction to Extubation
Tidsramme: Induction to extubation (3 hours on average)
Total anesthetic dose is measured in minimal alveolar concentration hours.
Induction to extubation (3 hours on average)

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

The Cleveland Clinic

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. december 2014

Primær færdiggørelse (Faktiske)

1. marts 2019

Studieafslutning (Faktiske)

1. oktober 2020

Datoer for studieregistrering

Først indsendt

3. juni 2014

Først indsendt, der opfyldte QC-kriterier

4. juni 2014

Først opslået (Skøn)

5. juni 2014

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

20. april 2021

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

25. marts 2021

Sidst verificeret

1. marts 2021

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 14-241

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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Kliniske forsøg med Intravenous Acetaminophen

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