Is There an Ideal Dose of Intravenous Fentanyl in the Prehospital Setting

NCT ID: NCT02914678

Last Updated: 2017-10-27

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

COMPLETED

Clinical Phase

NA

Total Enrollment

7093 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-10-31

Study Completion Date

2017-10-31

Brief Summary

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In a previous study the investigators evaluated the apparent efficacy and safety of intravenous fentanyl administered by ambulance personnel and found that 58.4% (CI 56.4-60.4) out of 2348 prehospital patients treated with fentanyl still experienced moderate to severe pain \[numeric rating scale (NRS, 0-10) \> 3\] at hospital arrival. The number of patients with possible fentanyl-related side effects was low.

Therefore, the aim of the present study is to explore the efficacy and safety of a liberalized pain treatment protocol for ambulance personnel (a total of 3 μg/kg per transport) compared with existing restrictive protocol (a total of 2 μg/kg per transport). The investigators hypothesize that:

* A higher proportion of patients will experience sufficient pain relief at hospital admission (NRS \< 4) using the liberalized protocol and
* There will be no differences in the proportion of potential fentanyl related side-effects are observed.

Detailed Description

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A prospective cluster-randomized trial observing proportional differences in sufficient pain relief at hospital admission (NRS \< 4) and potential fentanyl related side-effects between patients treated by ambulance personnel applying either:

* a more liberal treatment approach (a total of 3 μg/kg per transport) or
* existing treatment approach (a total of 2 μg/kg per transport).

The Ambulance stations and their affiliated ambulance personnel are stratified into 5 clusters according to size/average transports per month and randomized to either liberal or existing treatment approach within each cluster. As patients are not randomized on an individual level baseline differences between the two groups and its patients are adjusted statistically with relevant confounders on 3 overall levels:

1. Patients: Charlson Comorbidity Index Score, main overall diagnose category, inhospital surrogate measures of disease severity (intensive care unit admission and 30-day mortality).
2. Ambulance personnel: Years of experience and preinterventional cumulative fentanyl administration and
3. Ambulance stations and geographical factors: prehospital time measures and geographical distance from site of emergency to hospital.

These covariates are obtained from the Danish National Patient Registry, the Danish Civil Registration System and the electronic prehospital patient journal.

Conditions

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Acute Pain

Keywords

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Emergency Medical Services Analgesics

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Existing treatment

Business as usual: Ambulance personnel use existing treatment approach (a total of 2 μg/kg fentanyl per transport)

Group Type NO_INTERVENTION

No interventions assigned to this group

More liberal treatment

Ambulance personnel use a more liberal treatment approach (a total of 3 μg/kg fentanyl per transport)

Group Type EXPERIMENTAL

Fentanyl

Intervention Type OTHER

Change in protocol from 2 to a total of 3 μg/kg fentanyl per transport

Interventions

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Fentanyl

Change in protocol from 2 to a total of 3 μg/kg fentanyl per transport

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with acute pain treated with intravenous fentanyl by ambulance personnel

Exclusion Criteria

* Reduced conscious level (GCS \< 15) before initiation of fentanyl treatment
* Reduced respiratory rate (\< 10/minute) before initiation of fentanyl treatment
* Patient weight \< 30 kg
* Known opioid allergy
* Women in labour
* Chronic pain conditions
Maximum Eligible Age

110 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Central Denmark Region

OTHER

Sponsor Role collaborator

University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kristian Friesgaard, MD, PhD Student

Role: PRINCIPAL_INVESTIGATOR

University of Aarhus

Lone Nikolajsen, DmSc

Role: STUDY_CHAIR

Aarhus University Hospital

Hans Kirkegaard, Professor

Role: STUDY_CHAIR

Aarhus University Hospital

Erika Frischknecht Christensen, Professor

Role: STUDY_CHAIR

North Denmark Region

Matthias Giebner, MD

Role: STUDY_CHAIR

Central Denmark Region

Claus-Henrik Rasmussen, MD

Role: STUDY_CHAIR

Central Denmark Region

References

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Friesgaard KD, Nikolajsen L, Giebner M, Rasmussen CH, Riddervold IS, Kirkegaard H, Christensen EF. Efficacy and safety of intravenous fentanyl administered by ambulance personnel. Acta Anaesthesiol Scand. 2016 Apr;60(4):537-43. doi: 10.1111/aas.12662. Epub 2015 Nov 27.

Reference Type BACKGROUND
PMID: 26612100 (View on PubMed)

Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011 Jul;39(7 Suppl):30-3. doi: 10.1177/1403494811401482.

Reference Type BACKGROUND
PMID: 21775347 (View on PubMed)

Schmidt M, Pedersen L, Sorensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014 Aug;29(8):541-9. doi: 10.1007/s10654-014-9930-3. Epub 2014 Jun 26.

Reference Type BACKGROUND
PMID: 24965263 (View on PubMed)

Friesgaard KD, Kirkegaard H, Rasmussen CH, Giebner M, Christensen EF, Nikolajsen L. Prehospital intravenous fentanyl administered by ambulance personnel: a cluster-randomised comparison of two treatment protocols. Scand J Trauma Resusc Emerg Med. 2019 Feb 7;27(1):11. doi: 10.1186/s13049-019-0588-4.

Reference Type DERIVED
PMID: 30732618 (View on PubMed)

Other Identifiers

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AU-PHA2V3

Identifier Type: -

Identifier Source: org_study_id