Multimodal Narcotic Limited Perioperative Pain Control With Colorectal Surgery

NCT ID: NCT02958566

Last Updated: 2017-03-20

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2018-12-31

Brief Summary

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The General Objective of this study is to investigate the cost and efficacy of treating patients undergoing colorectal surgical resections with an opioid limited pain control regimen as part of an Enhanced Recovery After Surgery (ERAS) Protocol. This group will be compared to a traditional opioid based pain control regimen.

Detailed Description

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Postoperative ileus is a well-known problem for patients who have undergone a colorectal procedure. It is manifested as abdominal distension, accumulation of gas and fluid within the bowels and delayed bowel function (flatus or defecation). It is estimated that with traditional perioperative care for open colon resection postoperative ileus can lead to a length of stay (LOS) of 10 days. Such factors include the use of narcotics, immobilization, over-hydration with IV fluid etc. With about 350,000 colon and small bowel resections occurring annually and a bill to the healthcare system greater than US $20 billion, even decreasing LOS by one or two days can result in substantial cost savings.

All patients undergoing colorectal surgery require medications for pain control. The mainstay of current treatment includes narcotics/opioids. The effect of these medicines on mu receptors of the intestine contribute to delayed bowel function. Protocols that limit the use of narcotics/opioids may reduce the risk of ileus, thus reducing length of stay and reducing cost.

A prospective randomized clinical trial at a single tertiary referral academic affiliated medical center (OSF St. Francis Medical Center). Patients undergoing minimally invasive (laparoscopic or robotic) colorectal resection will be considered for inclusion. Surgery will be performed by two surgeons participating in the study protocol. Patient accrual is intended to begin May 1, 2016 and terminate either after 80 patients have been accrued or December 31, 2018, whichever is first. Informed consent will be obtained and preoperative education will be provided (appendix A). Patients will be randomized to one of two groups. The randomization scheme is a random-permuted-block design without stratification. The block size is a random number between 4 and 8. Personnel who are unassociated with patient screening, enrollment, or follow-up will create the allocation sequence and will use a computerized, random number generator. The allocation sequence will be transferred to sequentially numbered, opaque envelopes for purposes of allocation concealment. Clinical trial coordinators/physicians will verify patient eligibility and informed consent before opening the envelope to obtain the treatment assignment. The experimental group will be placed on a narcotic limited protocol as described below. All used medications are FDA approved. No investigational medicines will be used.

Conditions

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Colon Cancer Colon Diverticulosis Colonic Neoplasms Colonic Diverticulitis Pain, Postoperative Ileus Ileus Paralytic Ileus; Mechanical Constipation Drug Induced Constipation Rectum Cancer Rectum Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Narcotic

Morphine, Dilaudid or Fentanyl patient controlled anesthesia (PCA) for the immediate postoperative period, in addition to Norco 5-325 mg 1-2 tabs Q4H PRN, or equivalent medication.

Post-operative day 1: PCA will be discontinued and the patients will have IV narcotics PRN: Morphine 1-2 mg Q2H PRN, fentanyl 50-75 mcg Q2H PRN or Dilaudid 0.5 mg Q2H PRN

Group Type ACTIVE_COMPARATOR

Morphine Sulfate

Intervention Type DRUG

PCA

Fentanyl

Intervention Type DRUG

PCA

Dilaudid

Intervention Type DRUG

PCA

HYDROCODONE/ACETAMINOPHEN 5 Mg-325 Mg ORAL TABLET

Intervention Type DRUG

Breakthrough

Non-Narcotic

Gabapentin 300 mg PO, orphenadrine 60 mg IV, acetaminophen 1000 mg PO or IV on Morning of surgery. Lidocaine 100 mg prior to incision, lidocaine 1mg/kg/hour during procedure, marcaine in all incisions. Ketamine and methadone per anesthesia. Acetaminophen 1000 mg PO or IV, gabapentin 300 mg PO, tramadol 50 mg PO in PACU. Acetaminophen 600 mg PO Q 6 hours, tramadol 50 mg PO Q 6 hours, gabapentin 300 mg PO Q 6 hours, orphenadrine 60 mg IV Q 12 hours, ketorolac 15 mg IV Q 6 hours for 48 hours post-operatively.

Group Type EXPERIMENTAL

Acetaminophen

Intervention Type DRUG

Gabapentin

Intervention Type DRUG

Orphenadrine

Intervention Type DRUG

Lidocaine

Intervention Type DRUG

Marcaine

Intervention Type DRUG

Ketamine

Intervention Type DRUG

Methadone

Intervention Type DRUG

Tramadol

Intervention Type DRUG

Ketorolac

Intervention Type DRUG

Morphine Sulfate

Intervention Type DRUG

Fentanyl

Intervention Type DRUG

Dilaudid

Intervention Type DRUG

Hydrocodone-Acetaminophen Tab 5-325 MG

Intervention Type DRUG

Interventions

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Acetaminophen

Intervention Type DRUG

Gabapentin

Intervention Type DRUG

Orphenadrine

Intervention Type DRUG

Lidocaine

Intervention Type DRUG

Marcaine

Intervention Type DRUG

Ketamine

Intervention Type DRUG

Methadone

Intervention Type DRUG

Tramadol

Intervention Type DRUG

Ketorolac

Intervention Type DRUG

Morphine Sulfate

Intervention Type DRUG

Fentanyl

Intervention Type DRUG

Dilaudid

Intervention Type DRUG

Hydrocodone-Acetaminophen Tab 5-325 MG

Intervention Type DRUG

Morphine Sulfate

PCA

Intervention Type DRUG

Fentanyl

PCA

Intervention Type DRUG

Dilaudid

PCA

Intervention Type DRUG

HYDROCODONE/ACETAMINOPHEN 5 Mg-325 Mg ORAL TABLET

Breakthrough

Intervention Type DRUG

Other Intervention Names

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Tylenol Ofirmev Neurontin Norflex Ultram Toradol Norco Norco

Eligibility Criteria

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Inclusion Criteria

* Males or females above the age of 18
* Patients undergoing laparoscopic or robotic colorectal resections

Exclusion Criteria

* History of constipation
* Pre-existing use of narcotics or opioids
* Pre-existing renal or hepatic failure
* Mental illness, mental retardation, or inability to participate in informed consent due to mental status
* Pre-existing dementia
* Allergy to any protocol medication
* Emergency operation
* Subjects who are incarcerated or wards of the state
* Minors
* Subjects with inflammatory bowel disease, active colitis, or pre-existing intra-abdominal inflammation. Diverticulitis without active infection/inflammation will not be excluded.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Illinois College of Medicine at Peoria

OTHER

Sponsor Role lead

Responsible Party

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Steven Tsoraides

Assistant Professor of Clinical Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Steven S Tsoraides, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Illinois College of Medicine at Peoria

Locations

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Uicomp

Peoria, Illinois, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Mohammed Almzayyen, MD

Role: CONTACT

Marc A Sarran, MD

Role: CONTACT

Facility Contacts

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Steven S Tsoraides, MD/MPH

Role: primary

309-495-0200

References

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Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N; Zurich Fast Track Study Group. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology. 2009 Mar;136(3):842-7. doi: 10.1053/j.gastro.2008.10.030. Epub 2008 Nov 1.

Reference Type RESULT
PMID: 19135997 (View on PubMed)

Serclova Z, Dytrych P, Marvan J, Nova K, Hankeova Z, Ryska O, Slegrova Z, Buresova L, Travnikova L, Antos F. Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clin Nutr. 2009 Dec;28(6):618-24. doi: 10.1016/j.clnu.2009.05.009. Epub 2009 Jun 17.

Reference Type RESULT
PMID: 19535182 (View on PubMed)

Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag. 2008 Oct;4(5):913-7. doi: 10.2147/tcrm.s2390.

Reference Type RESULT
PMID: 19209273 (View on PubMed)

Other Identifiers

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825977-4

Identifier Type: -

Identifier Source: org_study_id

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