Narcotic vs. Non-narcotic Pain Regimens After Pediatric Appendectomy

NCT ID: NCT03528343

Last Updated: 2020-02-07

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

WITHDRAWN

Clinical Phase

PHASE1/PHASE2

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-05

Study Completion Date

2017-12-01

Brief Summary

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There is concern that pain prescription after outpatient pediatric surgical procedures is excessive and is in excess of patient need. Current practice following pediatric appendectomy is to prescribe all children with 5-15 doses of narcotic pain medication upon discharge regardless of their age, severity of appendicitis, or pain control in the hospital. This study examines the amount of narcotic pain control required by pediatric patients after undergoing appendectomy using a randomized controlled trial study design.

Pain control will be assessed with a post-operative pain scale, patient satisfaction survey, and parent satisfaction survey on the days following surgery and at post-operative follow-up.

The hypothesis is that the pain scores and patient satisfaction surveys will show no difference in post-operative pain control between the two arms.

Detailed Description

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There is concern that pain prescription after outpatient pediatric surgical procedures is excessive and is in excess of patient need. Current practice following pediatric appendectomy is to prescribe all children with 5-15 doses of narcotic pain medication upon discharge regardless of their age, severity of appendicitis, or pain control in the hospital. This study examines the amount of narcotic pain control required by pediatric patients after undergoing appendectomy using a randomized controlled trial study design.

Children admitted after undergoing surgical management for a diagnosis of acute appendicitis will be randomized at discharge to a narcotic arm or a tylenol/motrin arm. The narcotic arm will receive the standard of care narcotic prescription. The tylenol/motrin arm will receive education to use tylenol and motrin for pain control as well as a paper prescription provided for the sole purpose of rescue.

Pain control will be assessed with a post-operative pain scale, patient satisfaction survey, and parent satisfaction survey on the days following surgery and at post-operative follow-up.

The hypothesis is that the pain scores and patient satisfaction surveys will show no difference in post-operative pain control between the two arms.

Conditions

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Appendicitis 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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Tylenol/Motrin

Group of patients who will receive instructions to use tylenol and motrin for pain control, and parents will be sent home with a paper prescription with a rescue does of standard of care narcotics. They will be instructed to only use the rescue dose if pain is uncontrolled using over the counter medications.

Group Type EXPERIMENTAL

Non-narcotic pain control

Intervention Type DRUG

Education to use tylenol and motrin only for pain control unless this is unable to control pain. Rescue prescription provided.

Narcotic

Group of patients who will receive the standard of care narcotic prescription filled upon discharge.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Non-narcotic pain control

Education to use tylenol and motrin only for pain control unless this is unable to control pain. Rescue prescription provided.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Children ages 0 to 18 years old
* Patients have undergone appendectomy by any technique (open, laparoscopic, single-port)

Exclusion Criteria

* Patients on chronic opioids
* Patient undergoes a more extensive or additional procedures at the time of operation due to complications or other indication
* Pregnancy
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Primary Children's Hospital

OTHER

Sponsor Role collaborator

University of Utah

OTHER

Sponsor Role lead

Responsible Party

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Sean Stokes

General Surgery Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stephen J Fenton, MD

Role: PRINCIPAL_INVESTIGATOR

University of Utah, Primary Children's Hospital

Locations

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Primary Children's Hospital

Salt Lake City, Utah, United States

Site Status

Countries

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United States

References

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Blakely ML, Spurbeck WW, Lobe TE. Current status of laparoscopic appendectomy in children. Semin Pediatr Surg. 1998 Nov;7(4):225-7. doi: 10.1016/s1055-8586(98)70035-6.

Reference Type BACKGROUND
PMID: 9840903 (View on PubMed)

Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012 Jun 15;175(2):185-90. doi: 10.1016/j.jss.2011.07.017. Epub 2011 Aug 9.

Reference Type BACKGROUND
PMID: 22099604 (View on PubMed)

Tomecka MJ, Bortsov AV, Miller NR, Solano N, Narron J, McNaull PP, Ricketts KJ, Lupa CM, McLean SA. Substantial postoperative pain is common among children undergoing laparoscopic appendectomy. Paediatr Anaesth. 2012 Feb;22(2):130-5. doi: 10.1111/j.1460-9592.2011.03711.x. Epub 2011 Sep 29.

Reference Type BACKGROUND
PMID: 21958060 (View on PubMed)

Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013 Apr;118(4):934-44. doi: 10.1097/ALN.0b013e31828866b3.

Reference Type BACKGROUND
PMID: 23392233 (View on PubMed)

Finley AG, McGrath PJ, Forward PS, McNeill G, Fitzgerald P. Parents' management of children's pain following 'minor' surgery. Pain. 1996 Jan;64(1):83-87. doi: 10.1016/0304-3959(95)00091-7.

Reference Type BACKGROUND
PMID: 8867249 (View on PubMed)

Alkhoury F, Knight C, Stylianos S, Zerpa J, Pasaron R, Mora J, Aserlind A, Malvezzi L, Burnweit C. Prospective Comparison of Nonnarcotic versus Narcotic Outpatient Oral Analgesic Use after Laparoscopic Appendectomy and Early Discharge. Minim Invasive Surg. 2014;2014:509632. doi: 10.1155/2014/509632. Epub 2014 Apr 14.

Reference Type BACKGROUND
PMID: 24834350 (View on PubMed)

Chambers CT, Finley AG, McGrath PJ, Walsh TM. The parents' postoperative pain measure: replication and extension to 2-6-year-old children. Pain. 2003 Oct;105(3):437-443. doi: 10.1016/S0304-3959(03)00256-2.

Reference Type BACKGROUND
PMID: 14527704 (View on PubMed)

Abou-Karam M, Dube S, Kvann HS, Mollica C, Racine D, Bussieres JF, Lebel D, Nguyen C, Thibault M. Parental Report of Morphine Use at Home after Pediatric Surgery. J Pediatr. 2015 Sep;167(3):599-604.e1-2. doi: 10.1016/j.jpeds.2015.06.035. Epub 2015 Jul 21.

Reference Type BACKGROUND
PMID: 26205183 (View on PubMed)

Liu Y, Seipel C, Lopez ME, Nuchtern JG, Brandt ML, Fallon SC, Manyang PA, Tjia IM, Baijal RG, Watcha MF. A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children. Paediatr Anaesth. 2013 Dec;23(12):1187-92. doi: 10.1111/pan.12271. Epub 2013 Sep 25.

Reference Type BACKGROUND
PMID: 24112856 (View on PubMed)

Alkhoury F, Malvezzi L, Knight CG, Diana J, Pasaron R, Mora J, Aserlind A, Stylianos S, Burnweit C. Routine same-day discharge after acute or interval appendectomy in children: a prospective study. Arch Surg. 2012 May;147(5):443-6. doi: 10.1001/archsurg.2012.132.

Reference Type BACKGROUND
PMID: 22785642 (View on PubMed)

Stessel B, Theunissen M, Fiddelers AA, Joosten EA, Kessels AG, Gramke HF, Marcus MA. Controlled-release oxycodone versus naproxen at home after ambulatory surgery: a randomized controlled trial. Curr Ther Res Clin Exp. 2014 Nov 28;76:120-5. doi: 10.1016/j.curtheres.2014.10.001. eCollection 2014 Dec.

Reference Type BACKGROUND
PMID: 25516773 (View on PubMed)

Other Identifiers

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UU83426

Identifier Type: -

Identifier Source: org_study_id

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