Controlled-Release Oxycodone For Postoperative Analgesia After Video-Assisted Thoracic Surgery

NCT ID: NCT00681174

Last Updated: 2012-01-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

22 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-07-31

Study Completion Date

2010-11-30

Brief Summary

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The main hypothesis of this study is that preoperative administration of controlled-release (CR) oxycodone may reduce acute postoperative pain and improve time to discharge from the post-anesthesia care unit in patients undergoing video-assisted thoracoscopy for spontaneous pneumothorax.

The study drug will be compared with intravenous morphine administered 30 minutes before the end of anesthesia.

Detailed Description

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Although spontaneous pneumothorax may be treated conservatively by simple observation or chest tube insertion, up to 50% of patients treated conservatively may experience recurrence in subsequent months or years.

Video-assisted thoracic surgery (VATS) is a minimally-invasive surgical approach to treat spontaneous pneumothorax and reduce the risk of recurrence. Compared to open thoracotomy, VATS may facilitate a faster recovery and lead to earlier home discharge.

Totally-intravenous anesthesia (TIVA) with propofol and remifentanil is a useful anesthetic technique for VATS, as the drugs are rapidly eliminated after the end of the procedure, leading to fast recovery from anesthesia.

One drawback of ultra-short-acting opioid remifentanil is residual hyperalgesia after the end of the infusion, particularly after VATS, which is associated with relatively short but intense pain after surgery.

Intravenous morphine, administered just before the end of anesthesia, is the typical choice for pain relief after TIVA. However, this drug may require repeated titration and may be associated with postoperative nausea and vomiting, itchiness or drowsiness in the early postoperative period.

Oxycodone, another opioid, is available in an oral controlled-release (CR) formulation which grants relatively constant plasma levels of the drug after 1 h of administration.

The investigators hypothesize that administration of CR oxycodone 20 mg 1 hour before surgery may lead to better recovery parameters in the post-anesthesia care unit, thus granting earlier discharge to the surgical ward.

Conditions

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Anesthesia Recovery Period Pain, Postoperative

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Control

Control intervention will be intraoperative i.v. morphine administration 30 minutes before the end of anesthesia.

Group Type ACTIVE_COMPARATOR

Morphine

Intervention Type DRUG

0.15 mg/kg i.v. bolus, 30 minutes before the expected end of anesthesia

Paravertebral block

Intervention Type PROCEDURE

* Three injections of 0.5% ropivacaine, 5 ml each
* Injections at the T5, T6 and T7 levels

A 22G spinal needle will be used to contact the ipsilateral transverse process; the needle will be "walked off" the process and the injection will be made 1 cm deeper.

Propofol

Intervention Type DRUG

* Plasma concentration target-controlled infusion based on bispectral index values
* Acceptable range of concentrations: 2-4 µg/mL
* Target bispectral index values: 40-60
* Infusion starts at 4 µg/ml target, after pre-oxygenation (i.e., start of anesthesia)

Remifentanil

Intervention Type DRUG

* 50 µg/mL i.v. solution infused at 0.05-0.2 µg/kg/min
* Infusion starts 7 min before propofol infusion (i.e., start of anesthesia)
* Infusion rate adjusted to maintain mean arterial blood pressure within ±20% of baseline values.
* Infusion stopped after end of surgery and after patients are brought back to the supine position (i.e., end of anesthesia)

Paracetamol

Intervention Type DRUG

1 g i.v. bolus 30 min before the end of anesthesia; 1 g i.v. bolus q8h thereafter.

Morphine

Intervention Type DRUG

Patient-controlled intravenous infusion pump (IV-PCA).

* 50 mg morphine in 50 ml saline solution (1 mg/ml)
* Incremental dose: 1 mg
* Lock-out time: 8 min
* Limit: 40 mg in 4 h
* Background infusion: none

CROxy

The intervention group will receive controlled-release oxycodone 1 h pre-operatively

Group Type EXPERIMENTAL

oxycodone

Intervention Type DRUG

20 mg p.o. 1 h before the start of anesthesia

Paravertebral block

Intervention Type PROCEDURE

* Three injections of 0.5% ropivacaine, 5 ml each
* Injections at the T5, T6 and T7 levels

A 22G spinal needle will be used to contact the ipsilateral transverse process; the needle will be "walked off" the process and the injection will be made 1 cm deeper.

Propofol

Intervention Type DRUG

* Plasma concentration target-controlled infusion based on bispectral index values
* Acceptable range of concentrations: 2-4 µg/mL
* Target bispectral index values: 40-60
* Infusion starts at 4 µg/ml target, after pre-oxygenation (i.e., start of anesthesia)

Remifentanil

Intervention Type DRUG

* 50 µg/mL i.v. solution infused at 0.05-0.2 µg/kg/min
* Infusion starts 7 min before propofol infusion (i.e., start of anesthesia)
* Infusion rate adjusted to maintain mean arterial blood pressure within ±20% of baseline values.
* Infusion stopped after end of surgery and after patients are brought back to the supine position (i.e., end of anesthesia)

Paracetamol

Intervention Type DRUG

1 g i.v. bolus 30 min before the end of anesthesia; 1 g i.v. bolus q8h thereafter.

Morphine

Intervention Type DRUG

Patient-controlled intravenous infusion pump (IV-PCA).

* 50 mg morphine in 50 ml saline solution (1 mg/ml)
* Incremental dose: 1 mg
* Lock-out time: 8 min
* Limit: 40 mg in 4 h
* Background infusion: none

Interventions

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Morphine

0.15 mg/kg i.v. bolus, 30 minutes before the expected end of anesthesia

Intervention Type DRUG

oxycodone

20 mg p.o. 1 h before the start of anesthesia

Intervention Type DRUG

Paravertebral block

* Three injections of 0.5% ropivacaine, 5 ml each
* Injections at the T5, T6 and T7 levels

A 22G spinal needle will be used to contact the ipsilateral transverse process; the needle will be "walked off" the process and the injection will be made 1 cm deeper.

Intervention Type PROCEDURE

Propofol

* Plasma concentration target-controlled infusion based on bispectral index values
* Acceptable range of concentrations: 2-4 µg/mL
* Target bispectral index values: 40-60
* Infusion starts at 4 µg/ml target, after pre-oxygenation (i.e., start of anesthesia)

Intervention Type DRUG

Remifentanil

* 50 µg/mL i.v. solution infused at 0.05-0.2 µg/kg/min
* Infusion starts 7 min before propofol infusion (i.e., start of anesthesia)
* Infusion rate adjusted to maintain mean arterial blood pressure within ±20% of baseline values.
* Infusion stopped after end of surgery and after patients are brought back to the supine position (i.e., end of anesthesia)

Intervention Type DRUG

Paracetamol

1 g i.v. bolus 30 min before the end of anesthesia; 1 g i.v. bolus q8h thereafter.

Intervention Type DRUG

Morphine

Patient-controlled intravenous infusion pump (IV-PCA).

* 50 mg morphine in 50 ml saline solution (1 mg/ml)
* Incremental dose: 1 mg
* Lock-out time: 8 min
* Limit: 40 mg in 4 h
* Background infusion: none

Intervention Type DRUG

Other Intervention Names

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controlled-release oxycodone CR oxycodone OxyContin® Paravertebral nerve block Naropin® Propofol TCI target-controlled infusion TIVA TCI-TIVA TIVA-TCI Diprivan® TIVA Ultiva® Acetaminophen Perfalgan® PCA IVPCA IV-PCA PCA-IV Patient-controlled analgesia

Eligibility Criteria

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Inclusion Criteria

* Patients scheduled for video-assisted thoracic surgery for clinical diagnosis of spontaneous pneumothorax
* Must be able to swallow tablets 1 h before surgery
* American Society of Anesthesiologists (ASA) physical status class I or II

Exclusion Criteria

* Known allergy or other contraindications to study drugs
* Acute myocardial infarction ≤6 months before enrollment
* Serum creatinine \> 2 mg/dL
* Body mass index (BMI) \> 30
* Diagnosis of psychiatric disorders
* Known or possible pregnancy
* Epilepsy
* Chronic opioid therapy or abuse
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Parma

OTHER

Sponsor Role lead

Responsible Party

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Guido Fanelli

Professor of Anesthesiology and Critical Care Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guido Fanelli, MD

Role: STUDY_CHAIR

Section of Anesthesiology and Critical Care, Dept. of Anesthesiology, University of Parma, Italy

Marco Berti, MD

Role: STUDY_DIRECTOR

II Unit of Anesthesia, Critical Care and Pain Medicine, University Hospital of Parma, Italy

Franca Bridelli, MD

Role: PRINCIPAL_INVESTIGATOR

II Unit of Anesthesia, Critical Care and Pain Medicine, University Hospital of Parma, Italy

Locations

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University Hospital / Azienda Ospedaliero-Universitaria

Parma, PR, Italy

Site Status

Countries

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Italy

References

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Noppen M, Baumann MH. Pathogenesis and treatment of primary spontaneous pneumothorax: an overview. Respiration. 2003 Jul-Aug;70(4):431-8. doi: 10.1159/000072911.

Reference Type BACKGROUND
PMID: 14512683 (View on PubMed)

Hansen EG, Duedahl TH, Romsing J, Hilsted KL, Dahl JB. Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery. Acta Anaesthesiol Scand. 2005 Nov;49(10):1464-70. doi: 10.1111/j.1399-6576.2005.00861.x.

Reference Type BACKGROUND
PMID: 16223391 (View on PubMed)

Sunshine A, Olson NZ, Colon A, Rivera J, Kaiko RF, Fitzmartin RD, Reder RF, Goldenheim PD. Analgesic efficacy of controlled-release oxycodone in postoperative pain. J Clin Pharmacol. 1996 Jul;36(7):595-603. doi: 10.1002/j.1552-4604.1996.tb04223.x.

Reference Type BACKGROUND
PMID: 8844441 (View on PubMed)

Vogt A, Stieger DS, Theurillat C, Curatolo M. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth. 2005 Dec;95(6):816-21. doi: 10.1093/bja/aei250. Epub 2005 Sep 30.

Reference Type BACKGROUND
PMID: 16199417 (View on PubMed)

Kaya FN, Turker G, Basagan-Mogol E, Goren S, Bayram S, Gebitekin C. Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery. J Cardiothorac Vasc Anesth. 2006 Oct;20(5):639-43. doi: 10.1053/j.jvca.2006.03.022. Epub 2006 Aug 8.

Reference Type BACKGROUND
PMID: 17023279 (View on PubMed)

Other Identifiers

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ANEST-TOR-01

Identifier Type: -

Identifier Source: org_study_id

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