Clinical trial

Post-Op Pain Control for Prophylactic Intramedullary Nailing.

Name
28927
Description
Nationally, the opioid crisis has become a major epidemic with increasing mortality rates each year. Orthopedic surgeons routinely prescribe narcotics instead of NSAIDs for post-op pain control because of risk of delayed healing and nonunion due to NSAID use. Orthopedic oncology, however, has a unique subset of patients that undergo prophylactic placement of intramedullary femoral nails. Because no fracture is present, these patients do not rely on inflammatory healing factors, allowing for post-op NSAID use. This study sets out to determine the effect of post-op toradol use in addition to opioids compared to solely opioids in patients undergoing prophylactic nailing of the femur.
Trial arms
Trial start
2019-02-20
Estimated PCD
2024-08-01
Trial end
2024-10-01
Status
Recruiting
Phase
Early phase I
Treatment
Ketorolac
IV Ketorolac to be given over the course of the first 24 hours after surgery. See arm/group description for further details.
Arms:
Experimental Arm
Other names:
Toradol
Normal saline
An IV normal saline placebo prepared by the hospital pharmacy.
Arms:
Control
Other names:
Placebo
Acetaminophen
acetaminophen 500 mg PO Q4 hours PRN for mild pain
Arms:
Control, Experimental Arm
Other names:
Tylenol
Oxycodone Acetaminophen
oxycodone-acetaminophen 5-325 mg PO Q4 hours PRN for moderate to severe pain
Arms:
Control, Experimental Arm
Other names:
Percocet
Morphine
morphine IV PRN (or other opioid) for severe breakthrough pain
Arms:
Control, Experimental Arm
Hydrocodone/Acetaminophen
At discharge, patients will be prescribed 1-2 hydrocodone-acetaminophen 5-325 mg Q4 hours. Those with preexisting liver disease will be prescribed the equivalent in oxycodone.
Arms:
Control, Experimental Arm
Other names:
Norco
Oxycodone
Upon discharge, patients will be prescribed the equivalent of 1-2 hydrocodone 5mg Q4 hours upon should they have preexisting liver disease and are unable to consume acetaminophen.
Arms:
Control, Experimental Arm
Size
60
Primary endpoint
Milligram Morphine Equivalent (MME) of Opioid Medications Utilized
Post-op days 1-14
Eligibility criteria
Inclusion Criteria: 1. Femoral Shaft or Neck bone lesion 2. 18 years old or greater 3. Plan to undergo prophylactic intramedullary nailing of one femur Exclusion Criteria: 1. Concurrent pathologic fracture 2. History of advanced renal impairment (eGFR\<30mL/min) 3. History of Peptic Ulcer Disease with bleeding or requiring hospitalization 4. History of NSAID or aspirin allergy 5. Concurrent chemotherapy regimen that prevents NSAID use 6. History of liver disease that precludes use of toradol 7. History of heart failure or cardiovascular disease that precludes toradol usage 8. Pregnancy 9. History of narcotic allergy resulting in anaphylaxis 10. Patients with coagulation disorders or those who require concomitant use of anticoagulant or anti- platelet therapy during the treatment phase of the study. 11. Patients with acetaminophen allergies resulting in anaphylaxis 12. Current use of the medication probenecid 13. Current use of the medication Pentoxifylline 14. History of aspirin induced asthma. 15. Known history of opioid dependence, abuse, or addiction. 16. Bilateral IMN of the femurs
Protocol
{'studyType': 'INTERVENTIONAL', 'phases': ['PHASE3'], 'designInfo': {'allocation': 'RANDOMIZED', 'interventionModel': 'PARALLEL', 'interventionModelDescription': 'This study is a prospective, randomized, double-blind, placebo-controlled trial.', 'primaryPurpose': 'TREATMENT', 'maskingInfo': {'masking': 'DOUBLE', 'maskingDescription': 'Both the patient and study investigators will be blinded. The hospital pharmacy will be unblinded.', 'whoMasked': ['PARTICIPANT', 'INVESTIGATOR']}}, 'enrollmentInfo': {'count': 60, 'type': 'ESTIMATED'}}
Updated at
2023-12-01

1 organization

7 products

5 indications

Product
Ketorolac
Indication
Bone metastases
Indication
lymphoma
Indication
Opioid Use
Indication
Pain
Product
Morphine
Product
Oxycodone