Vaginal Postpartum Pain Management Protocol Comparison

NCT ID: NCT04087317

Last Updated: 2024-01-03

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

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-01

Study Completion Date

2022-07-30

Brief Summary

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Untreated postpartum pain has been associated with increased risk of opioid use, postpartum depression and development of persistent pain. In this study the investigators will investigate whether a scheduled administration of analgesics is superior to administration of analgesics based on patient request following a vaginal delivery.

Detailed Description

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More than two million women deliver vaginally every year in the United States (US). Along with the joy and happiness of having a new member in the family, women may suffer from cramping pain and lower abdomen discomfort following uterine involution; perineal pain due to perineal trauma or episiotomy; and nipple pain from breastfeeding or breast engorgement.

A stepwise approach using multimodal combination of medications can effectively provide an individualized pain management for women in their postpartum period. The first step includes non-opioid analgesics (as paracetamol and NSAIDs), step two adds milder opioids (as codeine, tramadol and oral morphine), and step three incorporates stronger opioids (as parenteral morphine).

In this study the investigators will investigate whether a scheduled administration of analgesics is superior to administration of analgesics based on patient request following a vaginal delivery.

Conditions

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Pain Post Partum Depression Opioid Use Breast Feeding

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Women following a vaginal delivery, with no exclusion criteria to participate in the study, will be addressed. After receiving all the information about the study, women who choose to participate will be consented.

All participants will be randomized to either scheduled analgesic administration (study group) or analgesic administration per women's request (control group) as accustomed at the investigator's unit.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Fixed time interval group.

Patients received oral 1-gram paracetamol and 400 milligram ibuprofen every 6 hours, in the first 24 hours postpartum. After 24 hours postpartum and until discharge, they will receive analgesics at maternal request. At any time, if a woman experienced pain despite the prescribed treatment, the next line of treatment was MIR (morphine immediate release, 10 mg tablet).

Group Type EXPERIMENTAL

Paracetamol 1000 Mg Oral Tablet

Intervention Type DRUG

The drug will be administrated when the woman arrive to the maternity unit, and every 6 hours thereafter, for first 24 hours following delivery.

Ibuprofen 400Mg Tab

Intervention Type DRUG

The drug will be administrated when the woman arrive to the maternity unit, and every 6 hours thereafter, for first 24 hours following delivery.

MIR

Intervention Type DRUG

At any time, if a woman experienced pain despite the prescribed treatment, the next line of treatment was MIR (morphine immediate release, 10 mg tablet).

'On-demand' group.

Patients received oral 1-gram paracetamol and 400 milligram ibuprofen at maternal request. At any time, if a woman experienced pain despite the prescribed treatment, the next line of treatment was MIR (morphine immediate release, 10 mg tablet).

Group Type EXPERIMENTAL

Paracetamol 1000 Mg Oral Tablet

Intervention Type DRUG

The drug will be administrated after a maternal request, by at least 6 hours apart between dosages.

Ibuprofen 400 mg

Intervention Type DRUG

The drug will be administrated after a maternal request, by at least 6 hours apart between dosages.

MIR

Intervention Type DRUG

At any time, if a woman experienced pain despite the prescribed treatment, the next line of treatment was MIR (morphine immediate release, 10 mg tablet).

Interventions

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Paracetamol 1000 Mg Oral Tablet

The drug will be administrated when the woman arrive to the maternity unit, and every 6 hours thereafter, for first 24 hours following delivery.

Intervention Type DRUG

Ibuprofen 400Mg Tab

The drug will be administrated when the woman arrive to the maternity unit, and every 6 hours thereafter, for first 24 hours following delivery.

Intervention Type DRUG

Paracetamol 1000 Mg Oral Tablet

The drug will be administrated after a maternal request, by at least 6 hours apart between dosages.

Intervention Type DRUG

Ibuprofen 400 mg

The drug will be administrated after a maternal request, by at least 6 hours apart between dosages.

Intervention Type DRUG

MIR

At any time, if a woman experienced pain despite the prescribed treatment, the next line of treatment was MIR (morphine immediate release, 10 mg tablet).

Intervention Type DRUG

Other Intervention Names

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Acetaminophen Acetaminophen

Eligibility Criteria

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Inclusion Criteria

1\. Women following term vaginal delivery.

Exclusion Criteria

1. Under Age 18 years or older than 45 years.
2. Women with chronic pain syndrome.
3. Women with relative or absolute contraindications for paracetamol or NSAIDs.
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Rambam Health Care Campus

OTHER

Sponsor Role lead

Responsible Party

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Gal Bachar MD

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gal Bachar, MD

Role: PRINCIPAL_INVESTIGATOR

Rambam Medical Health Center

Locations

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Rambam

Ramat Yishai, , Israel

Site Status

Countries

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Israel

References

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Bachar G, Alter A, Justman N, Buchnik Fater G, Farago N, Ben-David C, Abu-Rass H, Siegler Y, Hajaj A, Landau-Levin M, Zipori Y, Khatib N, Weiner Z, Vitner D. Fixed-time interval vs on-demand oral analgesia after vaginal delivery: a randomized controlled trial. Am J Obstet Gynecol MFM. 2024 May;6(5):101372. doi: 10.1016/j.ajogmf.2024.101372. Epub 2024 Apr 5.

Reference Type DERIVED
PMID: 38583715 (View on PubMed)

Deussen AR, Ashwood P, Martis R, Stewart F, Grzeskowiak LE. Relief of pain due to uterine cramping/involution after birth. Cochrane Database Syst Rev. 2020 Oct 20;10(10):CD004908. doi: 10.1002/14651858.CD004908.pub3.

Reference Type DERIVED
PMID: 33078388 (View on PubMed)

Other Identifiers

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Rambam Health Care Center.

Identifier Type: -

Identifier Source: org_study_id

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