Skuteczność przeciwbólowa i efekty położnicze tramadolu, paracetamolu i placebo w aktywnej fazie porodu (TRAMPA)
Skuteczność przeciwbólowa i efekty położnicze tramadolu, paracetamolu i placebo w czynnej fazie porodu: randomizowane, podwójnie ślepe, kontrolowane badanie
This randomized, double-blind, placebo-controlled trial aims to compare the analgesic efficacy and obstetric effects of tramadol (100 mg IV) versus paracetamol (1 g IV) versus placebo (saline solution) in nulliparous women during active labor. The primary outcome is duration of active labor (minutes). Secondary outcomes include duration of expulsive phase, type of delivery, need for oxytocin augmentation, maternal adverse events (nausea, vomiting, somnolence, hypotension), and neonatal outcomes (Apgar scores at 1 and 5 minutes, NICU admission). The study hypothesizes that tramadol significantly reduces active labor duration compared to paracetamol and placebo, without compromising maternal or neonatal safety. A total of 300 nulliparous women (100 per group) will be enrolled at Hospital Escuela, Tegucigalpa, Honduras.
Przegląd badań
Status
Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Szczegółowy opis
This is a randomized, double-blind, parallel-group, superiority efficacy trial comparing three interventions: tramadol 100 mg IV, paracetamol 1 g IV, and placebo (10 mL 0.9% saline solution) administered at the onset of active labor (cervical dilation ≥4 cm with regular contractions). The study design follows CONSORT guidelines for randomized controlled trials. Randomization will be performed using REDCap's automated randomization module in variable block sizes, ensuring allocation concealment. Double-blinding is maintained: participants, care providers, and outcome assessors are masked to group assignment. The primary endpoint is duration of active labor (minutes from intervention administration to complete cervical dilation). Secondary endpoints include: duration of expulsive phase (minutes), type of delivery (spontaneous vaginal, instrumental, cesarean), need for oxytocin augmentation, maternal adverse events (nausea, vomiting, somnolence, hypotension, pruritus, dizziness), neonatal Apgar scores at 1 and 5 minutes, birth weight, meconium-stained amniotic fluid, NICU admission, and neonatal asphyxia. Data collection includes sociodemographic variables (age, education, marital status, occupation), obstetric variables (gestational age, prenatal care visits, BMI, membrane status, cervical dilation at intervention, baseline fetal heart rate), and pain scores (Visual Analog Scale pre-intervention, 30 min, 1h, 2h post-intervention). Statistical analysis includes ANOVA or Kruskal-Wallis for continuous variables, chi-square for categorical variables, and logistic regression for binary outcomes, with significance set at p<0.05. A Data Safety Monitoring Board will oversee safety every 3 months. The study is funded by Universidad Nacional Autónoma de Honduras and will be conducted at Hospital Escuela, Tegucigalpa, from Feb. 2026 to June 2026.
Typ studiów
Typ studiów
Zapisy (Szacowany)
Zapisy
Faza
Faza
- Faza 4
Kontakty i lokalizacje
Kontakt w sprawie studiów
Kontakt w sprawie studiów
- Nazwa: Ricardo A. Gutierrez-Ramirez, MD, MSc
- Numer telefonu: +50497546940
- E-mail: ricardo.gutierrez@unah.edu.hn
Lokalizacje studiów
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Francisco Morazán Department
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Tegucigalpa, Francisco Morazán Department, Honduras, 11101
- Rekrutacyjny
- Hospital Escuela
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Kontakt:
- Ricardo A. Gutierrez Ramirez, MD, MSc.
- Numer telefonu: 50497546940
- E-mail: ricardo.gutierrez@unah.edu.hn
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Główny śledczy:
- Jessica M. Peña Ordoñez, MD
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Pod-śledczy:
- Jose A. Mendoza Rodriguez, MD
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Tegucigalpa, Francisco Morazán Department, Honduras, 11101
- Rekrutacyjny
- Instituto Hondureño de Seguridad Social
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Kontakt:
- Ricardo A. Gutierrez-Ramirez, MD, MSc.
- Numer telefonu: 50497546940
- E-mail: ricardo.gutierrez@unah.edu.hn
-
Główny śledczy:
- Ethel A. Cruz Valdivieso, MD
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Pod-śledczy:
- Raphael Amador Umanzor, MD
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Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
Inclusion Criteria:
- Nulliparous pregnant women
- Age between 15 and 45 years
- Singleton pregnancy, term (37-41 weeks gestation)
- Cephalic presentation
- Active labor defined as cervical dilation ≥4 cm with regular contractions
- Signed informed consent
Exclusion Criteria:
- Multiple gestation or high-risk pregnancy (preeclampsia, gestational diabetes, etc.)
- Known allergy or contraindication to tramadol or paracetamol
- Recent use (less than 6 hours) of any analgesic medication
- Previous cesarean section or other uterine surgery
- Active infection or fever at admission
- Inability to provide informed consent due to mental or communication conditions
- Non-cephalic presentation
- Rupture of membranes >18 hours without labor
- Participation in another clinical trial within the last 3 months
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Poczwórny
Liczba ramion
Broń i interwencje
Grupa uczestników / ArmGrupa uczestników / Arm |
Interwencja / LeczenieInterwencja / Leczenie |
|---|---|
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Eksperymentalny: Tramadol Group
Participants receive a single dose of tramadol 100 mg intravenously at the onset of active labor (cervical dilation ≥4 cm with regular contractions). |
Tramadol 100 mg administered as a single intravenous dose at the onset of active labor. Tramadol is an atypical opioid analgesic with serotonin and noradrenaline reuptake inhibition properties. The dose is within standard clinical ranges for obstetric analgesia. Administration is performed by trained medical personnel following institutional protocols. Participants are monitored for adverse effects including nausea, vomiting, somnolence, dizziness, and hypotension. |
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Eksperymentalny: Paracetamol Group
Participants receive a single dose of paracetamol 1 g intravenously (slow infusion) at the onset of active labor (cervical dilation ≥4 cm with regular contractions). |
Paracetamol 1 g administered as a single intravenous slow infusion at the onset of active labor. Paracetamol is a central analgesic acting through COX-3 inhibition in the central nervous system. It is widely used during pregnancy and labor due to its favorable safety profile. Administration is performed by trained medical personnel following institutional protocols. Participants are monitored for adverse effects including nausea, vomiting, and allergic reactions (rare). |
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Komparator placebo: Placebo Group
Participants receive a single dose of 10 mL 0.9% saline solution intravenously at the onset of active labor (cervical dilation ≥4 cm with regular contractions). |
Placebo consisting of 10 mL 0.9% saline solution administered as a single intravenous dose at the onset of active labor. The appearance and administration procedure are identical to the active interventions to maintain blinding. No pharmacological active ingredients are present. Administration is performed by trained medical personnel following institutional protocols. |
Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Duration of Active Labor
Ramy czasowe: From intervention administration (at active labor onset) up to 12 hours.
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Time in minutes from administration of study intervention (at onset of active labor defined as cervical dilation ≥4 cm with regular contractions) to complete cervical dilation (10 cm) or delivery, whichever occurs first. Measured and recorded by attending obstetric staff using standardized timing protocols. |
From intervention administration (at active labor onset) up to 12 hours.
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Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
Duration of Expulsive Phase (Second Stage)
Ramy czasowe: During delivery, from complete cervical dilation up to 120 minutes.
|
Time in minutes from complete cervical dilation (10 cm) to fetal expulsion. Measured and recorded by attending obstetric staff. |
During delivery, from complete cervical dilation up to 120 minutes.
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Type of Delivery
Ramy czasowe: At delivery
|
Classification of delivery outcome: spontaneous vaginal delivery, instrumental delivery (forceps or vacuum), or cesarean section. Assessed by attending obstetrician. |
At delivery
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Need for Oxytocin Augmentation
Ramy czasowe: During labor (from intervention administration up to 24 hours).
|
Requirement for additional oxytocin administration to augment uterine contractions during labor. Recorded as yes/no, including dose and timing if applicable. |
During labor (from intervention administration up to 24 hours).
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Maternal Adverse Events
Ramy czasowe: From intervention administration up to 24 hours postpartum.
|
Occurrence of any adverse events potentially related to the intervention, including: nausea, vomiting, somnolence, dizziness, headache, pruritus, hypotension (systolic BP <90 mmHg), or allergic reactions. Severity graded as mild, moderate, or severe. |
From intervention administration up to 24 hours postpartum.
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Neonatal Apgar Score at 5 Minutes
Ramy czasowe: At 5 minutes after birth.
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Apgar score assessed at 5 minutes after birth. Score ranges from 0-10, with higher scores indicating better neonatal condition. |
At 5 minutes after birth.
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Neonatal Complications
Ramy czasowe: From birth up to 48 hours, through hospital discharge.
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Occurrence of neonatal complications including: Apgar score <7 at 5 minutes, meconium-stained amniotic fluid, need for neonatal resuscitation, NICU admission, or neonatal asphyxia |
From birth up to 48 hours, through hospital discharge.
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Pain Scores (Visual Analog Scale)
Ramy czasowe: Pre-intervention, and at 30 minutes, 1 hour, and 2 hours post-intervention.
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Maternal pain assessed using Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst imaginable pain). Measured at baseline (pre-intervention), 30 minutes, 1 hour, and 2 hours post-intervention. |
Pre-intervention, and at 30 minutes, 1 hour, and 2 hours post-intervention.
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Inne miary wyników
Inne miary wyników
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Subgroup Analysis by Maternal Age
Ramy czasowe: Throughout study period, average of six months
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Comparison of primary and secondary outcomes stratified by maternal age categories (<20 years, 20-35 years, >35 years). |
Throughout study period, average of six months
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Współpracownicy i badacze
Sponsor
Sponsor
Publikacje i pomocne linki
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów (Rzeczywisty)
Rozpoczęcie studiów
Zakończenie podstawowe (Szacowany)
Zakończenie podstawowe
Ukończenie studiów (Szacowany)
Ukończenie studiów
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Rzeczywisty)
Pierwszy wysłany
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia wysłana aktualizacja
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
- Ból
- Objawy neurologiczne
- Stany patologiczne, oznaki i objawy
- Objawy i symptomy
- Ból porodowy
- Organiczne chemikalia
- Przygotowania farmaceutyczne
- Lipidy
- Anilidy
- Amides
- Związki aniliny
- Aminy
- Acetanilidy
- Rozwiązania krystaloidalne
- Rozwiązania izotoniczne
- Rozwiązania
- Alkohole
- Cykloheksanole
- Heksanole
- Tłuste alkohole
- Dimetyloaminowe
- Metyloamin
- Paracetamol
- Tramadol
- Roztwór soli fizjologicznej
Inne numery identyfikacyjne badania
Inne numery identyfikacyjne badania
- PO-UNAH-49-7-2026
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Opis planu IPD
Individual participant data (anonymized) will be shared for scientific purposes related to obstetric analgesia and labor management. Only de-identified datasets will be shared with qualified researchers upon reasonable request and with appropriate ethics committee approval. Participants will be informed of data sharing plans during the informed consent process and may opt out.
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Bada produkt urządzenia regulowany przez amerykańską FDA
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