- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT01861743
Multimodal Analgesia Versus Routine Care Pain Management (MMA)
Multimodal Analgesia Versus Routine Care Pain Management for Minimally Invasive Spine Surgery: A Prospective Randomized Study
Most patients undergoing surgery experience significant post-operative pain. Inadequate peri-operative pain management may decrease post-operative mobilization and increase length of hospitalization. Additionally, poorly managed acute post-operative pain analgesia is associated with an increased risk of developing chronic pain and delayed wound healing.
Lumbar spine surgery is particularly painful, often requiring a multi-day hospitalization. The most common post-operative analgesia used in spine surgery is narcotic medication delivered via an intravenous patient controlled analgesia (IV PCA).
A multimodal peri-operative pain management protocol for spine surgery has the potential to not only decrease pain but also to improve recovery, decrease narcotic consumption, decrease length of stay in the hospital and reduce both direct and indirect hospital costs.
The purpose of this study is to determine if post-operative pain and rate of recovery are improved in patients undergoing spine surgery using MMA compared to usual analgesic care.
Studieoversikt
Status
Intervensjon / Behandling
Detaljert beskrivelse
We hypothesize patients undergoing spinal fusion who receive peri-operative MMA will have:
- decreased post-operative pain compared to patients receiving usual care for pain management.
- shorter hospital LOS compared to patients receiving usual care pain management.
- fewer analgesic-related post-operative complications (urinary retention, ileus, etc) compared to patients receiving usual care pain management.
- improved physical functioning at the time of hospital discharge compared to patients receiving usual care pain management.
- better short and long term outcomes. Subjects will be randomized to MMA (Group 1) or usual care (Group 2). The unit of randomization will be a week (Monday through Sunday). Each week will randomly be assigned to MMA or usual care. Subjects who are hospitalized into a consecutive week will continue with the pain regimen they were assigned upon hospitalization.
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
-
-
Illinois
-
Chicago, Illinois, Forente stater, 60612
- Rush University Medical Center-Orthopedic Spine
-
-
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Barn
- Voksen
- Eldre voksen
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Patients undergoing single level MIS-TLIF
- Patients able to provide informed consent
Exclusion Criteria:
- Allergies or other contraindications to medicines in the protocol
- Current liver disease with documented liver function test abnormality
- Current renal disese with documented glomerular filtration rate (GFR) < 60 mL/min/1.73m2
- Baseline (pre-operative) opioid use greater than 30 mg of morphine equivalents/day
- Active alcohol dependence
- Active illicit drug dependence
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: Multimodal analgesia
multiple analgesic medications utilized in a synergistic manner to control pain while minimizing side-effects of individual drugs due to decreased doses.
This includes pre-operative patient education, intra-operative pain management and post-operative pain protocols.
|
Subjects are given medications preop, intraop and postop that implement a multi-modal approach to managing pain.
|
Aktiv komparator: Patient Controlled analgesia
Pain management using patient controlled narcotic analgesia.
|
Subjects will be treated with patient controlled narcotic analgesia for pain management.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Numeric pain scale
Tidsramme: Patients will be followed post-operatively while in the hospital (Avg 1-3 days), and a 6 weeks, 3 months, 6 months, 1 year and 2 years.
|
(a) While in the hospital, patients' pain is assessed by a nurse-driven protocol.
Assessments are every four to six hours, within 60 minutes after receiving an intravenous pain medication and within 90 minutes of receiving an oral pain medication.
This assessment includes rating subjective rating of ones pain on a verbal numeric rating scale (NRS) of 0-10.
The maximum pain score for each post-operative day will be compared.
|
Patients will be followed post-operatively while in the hospital (Avg 1-3 days), and a 6 weeks, 3 months, 6 months, 1 year and 2 years.
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Patient satisfaction
Tidsramme: Post operatively (avg: 1-3 days)
|
At each pain assessment (minimum every 4 hours), partients are asked if they are satisfied with their pain management.
(yes/no)
|
Post operatively (avg: 1-3 days)
|
Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Length of Stay
Tidsramme: Post operatively (avg: 1-3 days)
|
Post operatively (avg: 1-3 days)
|
|
Discharge destination
Tidsramme: Post operatively (avg:1-3 days)
|
Determine whether patients are discharged to home or to another facility (e.g.
rehab, etc)
|
Post operatively (avg:1-3 days)
|
Adverse events
Tidsramme: Post operatively (avg: 1-3 days)
|
Post operatively (avg: 1-3 days)
|
|
Disease specific and General health outcome measures
Tidsramme: Pre operatively (within 1 month of date of surgery) and Post operatively (6 weeks, 3months, 6 months, 1 year and 2 years)
|
Short form 36 and the Oswestry Disabilty Index
|
Pre operatively (within 1 month of date of surgery) and Post operatively (6 weeks, 3months, 6 months, 1 year and 2 years)
|
Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Frank M Phillips, MD, Rush University Medical Center
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Kim JC, Choi YS, Kim KN, Shim JK, Lee JY, Kwak YL. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 2011 Mar 15;36(6):428-33. doi: 10.1097/BRS.0b013e3181d26708.
- Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, Zdeblick TA, Resnick DK. Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech. 2010 Apr;23(2):139-45. doi: 10.1097/BSD.0b013e3181cf07ee.
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 13020402
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .
Kliniske studier på Spinal stenose
-
China National Center for Cardiovascular DiseasesRekrutteringDe Novo Stenosis | Medikamentbelagt ballong | Medikamentavgivende stentKina
-
IRCCS Azienda Ospedaliero-Universitaria di BolognaRekrutteringPCI | De Novo Stenosis | DCBItalia
-
Napa Pain InstituteVertos Medical, Inc.FullførtLumbal Spine Stenosis Central CanalForente stater
-
Zunyi Medical CollegeRekrutteringAkutt koronarsyndrom | De Novo StenosisKina
-
Xijing HospitalAktiv, ikke rekrutterendeKoronararteriesykdom | De Novo StenosisKina
-
Genoss Co., Ltd.FullførtPerifer arteriesykdom | De Novo StenosisKorea, Republikken
-
Xijing HospitalAktiv, ikke rekrutterendeKoronararteriesykdom | Perkutan koronar intervensjon | De Novo StenosisKina
-
General Administration of Military Health, TunisiaB. Braun Medical International Trading Company Ltd.RekrutteringKoronararteriesykdom (CAD) | De Novo Stenosis | Perkutan koronar intervensjon (PCI)Tunisia
-
Xijing HospitalRekrutteringDe Novo Stenosis | Alvorlig forkalkede koronare stenoserKina
-
Korea University Ansan HospitalB. Braun Korea Co., Ltd.RekrutteringKoronararteriesykdom | De Novo Stenosis | Aterosklerotisk plakkKorea, Republikken
Kliniske studier på Multimodal Analgesia
-
Centre Hospitalier Universitaire de NīmesRekruttering
-
China-Japan Friendship HospitalHar ikke rekruttert ennå
-
Gangnam Severance HospitalRekrutteringCytoreduktiv kirurgi | Hypertermisk intraperitoneal kjemoterapi | Peritoneal kreftKorea, Republikken
-
JIANG Zhi-WeiPfizerUkjent
-
Udayana UniversityFullførtBetennelse | Kronisk smerte | Inflammatorisk respons | Akutt smerteIndonesia
-
Centre Hospitalier Intercommunal de Toulon La Seyne...Fondation ApicilFullført
-
Massachusetts General HospitalTilbaketrukket
-
General Hospital PulaClinical Hospital Center RijekaUkjentKronisk smerte | Endometriose | Bekkenorganprolaps | Leiomyoma | Unormal livmorblødning | Premalign lesjonKroatia
-
Mohamed ElsayedUniversity of AlexandriaUkjentBedøvelsesmidler, hypotensive medikamenter, perioperativ analgesiEgypt
-
Montefiore Medical CenterFullførtAnestesi | BlokkereForente stater