Toradol v. Celecoxib for Postoperative Pain

NCT ID: NCT03331315

Last Updated: 2023-12-07

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

170 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-01

Study Completion Date

2017-01-01

Brief Summary

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Randomized control trial between ketorolac versus celecoxib for postoperative pain following hysterectomy.

Detailed Description

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Purpose:

To determine if Celebrex (Celecoxib) is as effective as Toradol (Ketorolac) at controlling postoperative pain when given in addition to standard postoperative pain control regimens.

Rationale:

Toradol (Ketorolac) is currently used by many surgeons as adjuvant therapy in addition to standard narcotics in managing immediate postoperative pain. Toradol (Ketorolac) is a non-steroidal anti-inflammatory drug that acts as a non-selective cyclooxygenase (COX), inhibiting COX-1 and COX-2 isoforms. (Toradol) Ketorolac has been associated with significant complications including postoperative bleeding and acute renal insufficiency. Celebrex (Celecoxib) is a selective COX-2 inhibitor that has been associated with adverse cardiovascular outcomes in patients with pre-existing cardiac disease but not with postoperative bleeding or renal insufficiency. Celebrex (Celecoxib) has also been shown to control postoperative pain but has never been compared to Toradol (Ketorolac).

Population:

Patients undergoing hysterectomy on the gynecology oncology service.

Design:

Randomized control trial.

Procedures:

All patients will receive a standard postoperative pain regimen with oral Tylenol (Acetaminophen), oral Lortab (Hydrocodone/Acetaminophen) as needed, and IV Dilaudid (Hydromorphone) as needed.

Randomization: Each participant will be assigned a number using a random number generator for assignment to one of the two postoperative pain regimens:

Arm 1:

Patients ages 18-65 will receive IV Toradol (Ketorolac) 30mg q6 hrs after their operation for 48 hrs or until hospital discharge if patients are discharged home in less than 48 hours after their operation.

\*\*Patients over age 65 will receive IV Toradol (Ketorolac) 15mg q6hrs instead of 30mg

Arm 2:

Patients who will receive oral Celebrex (Celecoxib) 400mg 1 hour prior to their procedure then 200mg oral twice daily for a total of seven days. Patients discharged prior to 7 days will be given a prescription for Celebrex (Celecoxib) to complete a total of 7 days.

Following surgery all patients will be given a postoperative questionnaire at the day of surgery, which was returned at the two week postoperative visit, examining time until return to ADLs, days of narcotic use, and number of narcotic pills used.

Conditions

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Pain, Postoperative

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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Ketorolac

Patients receiving scheduled ketorolac postoperatively

Group Type ACTIVE_COMPARATOR

Ketorolac

Intervention Type DRUG

Celecoxib

Patients receiving celebrex preoperative and postoperatively for 7 days

Group Type EXPERIMENTAL

Celecoxib

Intervention Type DRUG

Interventions

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Celecoxib

Intervention Type DRUG

Ketorolac

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing hysterectomy

Exclusion Criteria

* Coronary Artery Disease
* Peptic Ulcer Disease
* Chronic Renal Disease
* Liver disease
* Alcohol Abuse
* Daily narcotic usage
* Narcotic use 24 hours prior to surgery
* Crohn's Disease
* History of myocardial infarction
* History of stroke
* Preoperative hematocrit less than 24
* Asthma
* Ulcerative Colitis
* Diverticulitis
* Aspirin Allergy
* Sulfonamide Allergy
* Pre-operative pain score of greater than 3
* Patients undergoing procedures that may involve bowel resection or bowel reanastomosis.
* Allergy to any non-steroidal anti-inflammatory drug
* Cardiac anomaly or disease
* Congestive Heart Failure
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Michael Ulm, MD

OTHER

Sponsor Role lead

Responsible Party

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Michael Ulm, MD

Priniciple Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Michael A Ulm, MD

Role: PRINCIPAL_INVESTIGATOR

University of Tennessee

Locations

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Methodist Hospital System

Memphis, Tennessee, United States

Site Status

Countries

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United States

References

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Azari L, Santoso JT, Osborne SE. Optimal pain management in total abdominal hysterectomy. Obstet Gynecol Surv. 2013 Mar;68(3):215-27. doi: 10.1097/OGX.0b013e31827f5119.

Reference Type BACKGROUND
PMID: 23945838 (View on PubMed)

Blanton E, Lamvu G, Patanwala I, Barron KI, Witzeman K, Tu FF, As-Sanie S. Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review. Am J Obstet Gynecol. 2017 Jun;216(6):557-567. doi: 10.1016/j.ajog.2016.12.175. Epub 2016 Dec 30.

Reference Type BACKGROUND
PMID: 28043841 (View on PubMed)

Strom BL, Berlin JA, Kinman JL, Spitz PW, Hennessy S, Feldman H, Kimmel S, Carson JL. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA. 1996 Feb 7;275(5):376-82.

Reference Type BACKGROUND
PMID: 8569017 (View on PubMed)

Gong L, Thorn CF, Bertagnolli MM, Grosser T, Altman RB, Klein TE. Celecoxib pathways: pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics. 2012 Apr;22(4):310-8. doi: 10.1097/FPC.0b013e32834f94cb. No abstract available.

Reference Type BACKGROUND
PMID: 22336956 (View on PubMed)

Other Identifiers

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12-02041-FB

Identifier Type: -

Identifier Source: org_study_id