Pain Medications Following Thyroidectomy and Parathyroidectomy

NCT ID: NCT03640247

Last Updated: 2019-12-26

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

PHASE1

Total Enrollment

126 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-15

Study Completion Date

2019-12-01

Brief Summary

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The purpose of this study is to evaluate the use of a non-narcotic, postoperative pain management regimen on patients undergoing thyroidectomy and parathyroidectomy.

Detailed Description

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The purpose of this study is to evaluate the use of a non-narcotic, postoperative pain management regimen for patients undergoing thyroidectomy and parathyroidectomy. The investigators hypothesize that participants receiving non-narcotic pain regimens will have equivalent pain control and satisfaction to those who receive narcotic pain medicines.

The primary objective will be to identify if there is a difference in average perceived postoperative pain scores between participants who do and do not receive narcotic pain medications. Secondary outcomes will include need for breakthrough pain medications, patient satisfaction scores and the need to call the surgeon office for additional pain medications.

The participant will undergo total thyroidectomy, partial thyroidectomy or parathyroidectomy per the standard of care. The study will have no influence on the surgical procedure performed.

Following the surgery, postoperative analgesia regimens will be prescribed based on study randomization.

Narcotic group regimen (63 patients):

* Tylenol tablet 1000 mg by mouth every 8 hours alternating with
* Ibuprofen tablet 800 mg by mouth every 8 hours
* Oxycodone 5 mg by mouth every 6 hours as needed for pain, #10 tablets

Non-narcotic group regimen (63 patients):

* Tylenol tablet 1000 mg by mouth every 8 hours alternating with
* Ibuprofen tablet 800 mg by mouth every 8 hours

Participants will be asked to complete a survey each day for the initial 5 days postoperatively. Survey data includes:

* Average pain level using the 10-point visual analogue scale
* Ease of following the pain regimen using a 3-point liker scale
* Total dose of oral narcotics converted into oral morphine equivalents that were taken by participants post-operatively
* If the patient needed to call the office due to inadequately controlled pain

If the participants do not have adequate pain control with the non-narcotic regimen, they may be prescribed additional narcotic pain medication at the discretion of the PI and remain enrolled in the study.

The investigators will also review participants charts for information regarding any postoperative office calls regarding postoperative needs (i.e. for pain medications).

The medical surgical information below is gathered as standard of care for each surgical procedure and will also be collected as part of this procedure:

* Patient name, medical record number
* Patient demographics (age, gender, BMI, ASA score)
* Past medical History
* Past surgical history
* Past social history
* Preoperative medications (including steroids, anticoagulation, opioid use)
* Pre-operative diagnosis
* Procedure performed and pain medications administered in the post-ambulatory care unit
* Postoperative complications including need for readmission within 30 days
* Length of stay in hospital

Conditions

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Thyroid Disease Parathyroid Diseases

Keywords

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Thyroidectomy Parathryoidectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

All party or parties involved have knowledge of the interventions assigned to individual participants

Study Groups

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Narcotic group regimen

* Tylenol tablet 1000 mg by mouth every 8 hours alternating with
* Ibuprofen tablet 800 mg by mouth every 8 hours
* Oxycodone 5 mg by mouth every 6 hours as needed for pain, #10 tablet or if needed based on patient allergies, hydrocodone 5 mg/tramadol 50 mg.

Group Type OTHER

Narcotic group regimen

Intervention Type DRUG

Narcotic Group: Alternating acetaminophen and ibuprofen, with a prescription of 10 tablets oxycodone (or if needed based on patient allergies, hydrocodone 5 mg/tramadol 50 mg) for break through pain.

Non-narcotic group regimen

* Tylenol tablet 1000 mg by mouth every 8 hours alternating with
* Ibuprofen tablet 800 mg by mouth every 8 hours

Group Type ACTIVE_COMPARATOR

Non-narcotic group regimen

Intervention Type DRUG

Non-Narcotic Group. Receives only alternating acetaminophen and ibuprofen

Interventions

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Non-narcotic group regimen

Non-Narcotic Group. Receives only alternating acetaminophen and ibuprofen

Intervention Type DRUG

Narcotic group regimen

Narcotic Group: Alternating acetaminophen and ibuprofen, with a prescription of 10 tablets oxycodone (or if needed based on patient allergies, hydrocodone 5 mg/tramadol 50 mg) for break through pain.

Intervention Type DRUG

Other Intervention Names

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Ibuprofen 800mg every 8 hours Acetaminophen 500Mg Tab x2 every 8 hours Ibuprofen 800mg every 8 hours Oxycodone 5mg every 6 hours prn for pain. Hydrocodone 5 mg every 6 hours prn for pain Tramadol 50 mg every 6 hours prn for pain Acetaminophen 500Mg Tab x2 every 8 hours

Eligibility Criteria

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Inclusion Criteria

* Age 18 years or greater
* Undergoing total thyroidectomy, partial thyroidectomy or parathyroidectomy at MetroHealth Medical Center

Exclusion Criteria

* Patients taking narcotics prior to surgery
* Patients who are unable or unwilling to follow study protocol requirements
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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MetroHealth Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Christopher McHenry

MD, Director, Division of General Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christopher R McHenry, MD

Role: PRINCIPAL_INVESTIGATOR

MetroHealth Medical Center

Locations

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MetroHealth Medical Center

Cleveland, Ohio, United States

Site Status

Countries

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United States

References

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Fujii MH, Hodges AC, Russell RL, Roensch K, Beynnon B, Ahern TP, Holoch P, Moore JS, Ames SE, MacLean CD. Post-Discharge Opioid Prescribing and Use after Common Surgical Procedure. J Am Coll Surg. 2018 Jun;226(6):1004-1012. doi: 10.1016/j.jamcollsurg.2018.01.058. Epub 2018 Feb 28.

Reference Type BACKGROUND
PMID: 29499361 (View on PubMed)

Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. J Am Coll Surg. 2018 Jun;226(6):996-1003. doi: 10.1016/j.jamcollsurg.2017.10.012. Epub 2017 Nov 30.

Reference Type BACKGROUND
PMID: 29198638 (View on PubMed)

Long SM, Lumley CJ, Zeymo A, Davidson BJ. Prescription and Usage Pattern of Opioids after Thyroid and Parathyroid Surgery. Otolaryngol Head Neck Surg. 2019 Mar;160(3):388-393. doi: 10.1177/0194599818779776. Epub 2018 May 29.

Reference Type BACKGROUND
PMID: 29807482 (View on PubMed)

Lou I, Chennell TB, Schaefer SC, Chen H, Sippel RS, Balentine C, Schneider DF, Moalem J. Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience. Ann Surg Oncol. 2017 Jul;24(7):1951-1957. doi: 10.1245/s10434-017-5781-y. Epub 2017 Feb 3.

Reference Type BACKGROUND
PMID: 28160140 (View on PubMed)

Tan WH, Yu J, Feaman S, McAllister JM, Kahan LG, Quasebarth MA, Blatnik JA, Eagon JC, Awad MM, Brunt LM. Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use. J Am Coll Surg. 2018 Aug;227(2):203-211. doi: 10.1016/j.jamcollsurg.2018.04.032. Epub 2018 May 7.

Reference Type BACKGROUND
PMID: 29746919 (View on PubMed)

Brady JT, Dreimiller A, Miller-Spalding S, Gesang T, Sehgal AR, McHenry CR. Are narcotic pain medications necessary after discharge following thyroidectomy and parathyroidectomy? Surgery. 2021 Jan;169(1):202-208. doi: 10.1016/j.surg.2020.03.027. Epub 2020 May 14.

Reference Type DERIVED
PMID: 32416981 (View on PubMed)

Other Identifiers

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IRB18-00412

Identifier Type: -

Identifier Source: org_study_id