Perioperative Analgesia on Postoperative Opioid Usage and Pain Control in H&N Cancer Surgery

NCT ID: NCT04176419

Last Updated: 2024-11-12

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

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-17

Study Completion Date

2021-06-23

Brief Summary

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The purpose of this study is to determine how a non-opioid pain control regimen, administered before and during surgery, will affect postoperative pain control and total opioid consumption in head and neck cancer participants undergoing cancer surgery with free flap reconstruction.

Detailed Description

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This study will help the study team determine how the experimental, non-opioid pain control regimen affects opioid-related side effects, participant satisfaction with pain management, PACU length of stay, hospital length of stay, chronic pain level, and chronic pain-related disability in participants, and to determine the safety and tolerability of the non-opioid pain control regimen in head and neck cancer patients undergoing cancer surgery with free flap reconstruction. Ketamine, Lidocaine, Acetaminophen, Gabapentin, and Celecoxib are FDA-approved drugs that have been approved for use individually, and have been used in combination for perioperative pain control. However, the use of these five drugs together in head and neck cancer patients undergoing free flap reconstruction has not been studied, which is why this study is experimental.

Conditions

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Postoperative Pain Control Opioid Consumption

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Treatment Group

Perioperative intervention (preoperative acetaminophen, gabapentin, and celecoxib and intraoperative ketamine and lidocaine).

The Investigational Drug Service will mix and prepare the study medications necessary for each participant. An Investigational Drug Service staff member will deliver the oral medications to the nursing team in the preoperative holding unit and the IV medications to the anesthesia team in the OR unit.

Group Type EXPERIMENTAL

Ketamine

Intervention Type DRUG

0.25 mg/kg IV bolus before incision, followed by 0.005 mg/kg/minute IV for the remainder of the surgical case excluding the final 30-45 minutes.

Lidocaine

Intervention Type DRUG

1.5 mg/kg IV bolus before incision, followed by infusion of 1.5 mg/kg/hour ideal body weight (max 8 hours) during the case

Acetaminophen

Intervention Type DRUG

1,000 mg orally at time of check-in to the preoperative unit

Gabapentin

Intervention Type DRUG

600 mg orally at time of check in to the preoperative unit

Celecoxib

Intervention Type DRUG

200 mg orally at time of check in to the preoperative unit

Control Group

Perioperative placebo

Placebo oral drugs will be encapsulated versions provided by the Investigational Drug Service and will appear identical to the interventional oral drugs. Placebo IV infusions will be prepared by Investigational Drug Service as per institutional guidelines and will appear identical to the interventional IV drugs.

Group Type PLACEBO_COMPARATOR

Placebo Ketamine

Intervention Type DRUG

0.25 mg/kg IV bolus before incision, followed by 0.005 mg/kg/minute IV for the remainder of the surgical case excluding the final 30-45 minutes.

Placebo Lidocaine

Intervention Type DRUG

1.5 mg/kg IV bolus before incision, followed by infusion of 1.5 mg/kg/hour ideal body weight (max 8 hours) during the case

Placebo Acetaminophen

Intervention Type DRUG

1,000 mg orally at time of check-in to the preoperative unit

Placebo Gabapentin

Intervention Type DRUG

600 mg orally at time of check in to the preoperative unit

Placebo Celecoxib

Intervention Type DRUG

200 mg orally at time of check in to the preoperative unit

Interventions

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Ketamine

0.25 mg/kg IV bolus before incision, followed by 0.005 mg/kg/minute IV for the remainder of the surgical case excluding the final 30-45 minutes.

Intervention Type DRUG

Placebo Ketamine

0.25 mg/kg IV bolus before incision, followed by 0.005 mg/kg/minute IV for the remainder of the surgical case excluding the final 30-45 minutes.

Intervention Type DRUG

Lidocaine

1.5 mg/kg IV bolus before incision, followed by infusion of 1.5 mg/kg/hour ideal body weight (max 8 hours) during the case

Intervention Type DRUG

Placebo Lidocaine

1.5 mg/kg IV bolus before incision, followed by infusion of 1.5 mg/kg/hour ideal body weight (max 8 hours) during the case

Intervention Type DRUG

Acetaminophen

1,000 mg orally at time of check-in to the preoperative unit

Intervention Type DRUG

Placebo Acetaminophen

1,000 mg orally at time of check-in to the preoperative unit

Intervention Type DRUG

Gabapentin

600 mg orally at time of check in to the preoperative unit

Intervention Type DRUG

Placebo Gabapentin

600 mg orally at time of check in to the preoperative unit

Intervention Type DRUG

Celecoxib

200 mg orally at time of check in to the preoperative unit

Intervention Type DRUG

Placebo Celecoxib

200 mg orally at time of check in to the preoperative unit

Intervention Type DRUG

Other Intervention Names

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Ketamine Hydrochloride Ketamine Hydrochloride Injection USP Lidocaine Hydrochloride and 5% dextrose lidocaine hydrochloride injection Paracetamol Tylenol N-acetyl-para-aminophenol APAP Neurontin Celebrex

Eligibility Criteria

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Inclusion Criteria

* Undergoing head \& neck free flap reconstruction at the Cleveland Clinic Main Campus
* Subjects must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria

* History of allergy to lidocaine, ketamine, acetaminophen, gabapentin, and/or celecoxib
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to Ketamine, Lidocaine or other agents used in this study
* Subjects receiving any other investigational agents
* Inadequate renal function (serum creatinine ≥ 2 mg/dl) within 30 days
* Inadequate hepatic function (total bilirubin ≥ 2 x the institutional ULN and/or AST or ALT ≥3 x the institutional ULN) within 30 days
* Known or suspected history of illicit drug abuse (including opioids but excluding tobacco and EtOH) within the past 6 months
* Pregnancy
* Contraindication to lidocaine (heart block, heart failure with EF \< 30%) as determined by history of Congestive Heart Failure, or as determined by preoperative evaluation for surgical clearance
* In the opinion of the investigator, subjects with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Case Comprehensive Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jamie Ku, MD

Role: PRINCIPAL_INVESTIGATOR

Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center

Locations

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Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center

Cleveland, Ohio, United States

Site Status

Countries

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United States

Other Identifiers

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CASE6319

Identifier Type: -

Identifier Source: org_study_id

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