A Dose Ranging Effect of Preoperative Diphenhydramine on Postoperative Quality of Recovery After Ambulatory Surgery

NCT ID: NCT01451762

Last Updated: 2014-03-14

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2012-09-30

Brief Summary

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Pain after ambulatory surgery remains an unsolved problem in The United States and Europe. It is associated with delayed hospital discharge and it can result to an increased opioid consumption with adverse side effects. The concept of multimodal analgesic technique was introduced more than 15 years ago and several techniques have been studied over the years including non steroidal antiinflammatory drugs (NSAIDs), acetaminophen, gabapentoids, ketamine, local and regional anesthetic techniques. Histamine can have effects on polymodal nociceptors and C-fibers, producing pain which is further increased by neurogenically mediated release of substance P from afferent pain fibers. Several non-selective or H1 -selective histamine receptors antagonists have been demonstrated in animal models and clinical pain. Chia et al demonstrated that preoperative promethazine had opioid sparing properties without adverse sedative effects in patients undergoing abdominal hysterectomy.

Diphenhydramine is an anti-histamine drug who has been found to be effective in reducing postoperative nausea and vomiting after ambulatory surgery but its effects on postoperative pain and other important outcomes after ambulatory surgery such as time to meet discharge criteria have not being studied.

The MQOR 40 is a validated instrument that was specifically design to evaluate patient recovery after anesthesia and surgery. This instrument can be particularly valid to examine interventions which affect different spheres of patient recovery as is the case of diphenhydramine. The objective of this study is to determine a dose response effect of preoperative diphenhydramine on postoperative quality of recovery after ambulatory surgery. The use of preoperative diphenhydramine can improve patient's quality of recovery, decrease postoperative pain, opioid consumption and opioid related side effects after ambulatory surgery.

The research question: Does a preoperative dose of diphenhydramine improve postoperative quality of recovery after ambulatory surgery? The hypothesis of this study is that preoperative diphenhydramine will improve postoperative pain, Postoperative nausea and vomiting (PONV), sleep which will translate in a better overall quality of recovery.

Detailed Description

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Conditions

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Surgery Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Placebo

.9 normal saline IV

Group Type PLACEBO_COMPARATOR

.9 normal saline

Intervention Type DRUG

.9 normal saline administered before surgery.

25 mg diphenhydramine IV

25 mg diphenhydramine IV administered before surgery

Group Type ACTIVE_COMPARATOR

25 mg diphenhydramine IV

Intervention Type DRUG

25 mg diphenhydramine IV administered before surgery

50 mg diphenhydramine IV

50 mg diphenhydramine IV administered before surgery

Group Type ACTIVE_COMPARATOR

50 mg diphenhydramine IV

Intervention Type DRUG

50 mg diphenhydramine administered IV before surgery

Interventions

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.9 normal saline

.9 normal saline administered before surgery.

Intervention Type DRUG

25 mg diphenhydramine IV

25 mg diphenhydramine IV administered before surgery

Intervention Type DRUG

50 mg diphenhydramine IV

50 mg diphenhydramine administered IV before surgery

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age 18-64 years
* Patients undergoing ambulatory surgery
* ASA PS I, II.

Exclusion Criteria

* Chronic opioid use
* pregnant patient or lactating patients
* allergy to diphenhydramine
* glaucoma
* uncontrolled hypertension
* asthma
* hyperthyroidism
* cardiovascular disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

64 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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Gildasio De Oliveira

Gildasio De Oliveira, M.D. Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gildasio De Oliveira, MD

Role: PRINCIPAL_INVESTIGATOR

Northwestern University

Locations

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Prentice Womens HOspital

Chicago, Illinois, United States

Site Status

Prentice Womens HOsptial

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003 Aug;97(2):534-540. doi: 10.1213/01.ANE.0000068822.10113.9E.

Reference Type BACKGROUND
PMID: 12873949 (View on PubMed)

Benhamou D, Berti M, Brodner G, De Andres J, Draisci G, Moreno-Azcoita M, Neugebauer EA, Schwenk W, Torres LM, Viel E. Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain. 2008 May;136(1-2):134-41. doi: 10.1016/j.pain.2007.06.028. Epub 2007 Aug 20.

Reference Type BACKGROUND
PMID: 17703887 (View on PubMed)

Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993 Nov;77(5):1048-56. doi: 10.1213/00000539-199311000-00030. No abstract available.

Reference Type BACKGROUND
PMID: 8105724 (View on PubMed)

White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? Anesthesiology. 2010 Jan;112(1):220-5. doi: 10.1097/ALN.0b013e3181c6316e. No abstract available.

Reference Type BACKGROUND
PMID: 20010418 (View on PubMed)

Schmelz M, Schmidt R, Bickel A, Handwerker HO, Torebjork HE. Specific C-receptors for itch in human skin. J Neurosci. 1997 Oct 15;17(20):8003-8. doi: 10.1523/JNEUROSCI.17-20-08003.1997.

Reference Type BACKGROUND
PMID: 9315918 (View on PubMed)

Baird-Lambert J, Jamieson DD. Possible mediators of the writhing response induced by acetic acid or phenylbenzoquinone in mice. Clin Exp Pharmacol Physiol. 1983 Jan-Feb;10(1):15-20. doi: 10.1111/j.1440-1681.1983.tb00166.x.

Reference Type BACKGROUND
PMID: 6188566 (View on PubMed)

Rumore MM, Schlichting DA. Analgesic effects of antihistaminics. Life Sci. 1985 Feb 4;36(5):403-16. doi: 10.1016/0024-3205(85)90252-8.

Reference Type BACKGROUND
PMID: 2578597 (View on PubMed)

Raffa RB. Antihistamines as analgesics. J Clin Pharm Ther. 2001 Apr;26(2):81-5. doi: 10.1046/j.1365-2710.2001.00330.x.

Reference Type BACKGROUND
PMID: 11350529 (View on PubMed)

Other Identifiers

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STU00044695

Identifier Type: -

Identifier Source: org_study_id

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