Effect of Paracetamol and Ibuprofen Reducing Morphine Requirements After Total Knee Arthroplasty

NCT ID: NCT04414995

Last Updated: 2020-12-22

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

PHASE2/PHASE3

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-05

Study Completion Date

2020-12-15

Brief Summary

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Adequate pain management has an important role in supporting early ambulation after the Total Knee Arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of combination Paracetamol and Ibuprofen injection is expected to reduce total morphine consumption after TKA.

Detailed Description

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The research will compare the effect of paracetamol injection and ibuprofen injection when given alone or in combination to reduce morphine requirement in a patient after total knee arthroplasty

Conditions

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Analgesia

Keywords

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multi modal analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Patients in Group 1 received a combination of 1000 mg IV paracetamol and 800 mg IV ibuprofen at the end of operation followed by 1000 mg IV paracetamol and 800 mg IV ibuprofen every 6 hours up to 72 hours.

Patients in Group 2 received 1000 mg IV paracetamol and 100 ml IV normal salines at the end of operation followed by 1000 mg IV paracetamol and 100 ml IV normal salines every 6 hours up to 72 hours.

Patients in Group 3 received 800 mg IV ibuprofen and 100 ml IV normal salines at the end of operation followed by 800 mg IV ibuprofen and 100 ml IV normal salines every 6 hours up to 72 hours.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
The study medication will be masked by the pharmacy. Participants, those administrating the intervention, other caregivers, outcome assessors, data managers, statisticians, and investigators drawing conclusions will be blinded to the intervention.

Study Groups

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Paracetamol+Ibuprofen

Patients in Group 1 will receive a combination of 1000 mg IV paracetamol and 800 mg IV ibuprofen at the end of operation following by 1000 mg IV paracetamol and 800 mg IV ibuprofen every 6 hours up to 72 hours.

Group Type EXPERIMENTAL

Paracetamol injection and Ibuprofen injection

Intervention Type DRUG

Use of combination acetaminophen and ibuprofen to reduce morphine requirement inpatient after Total knee arthroplasty

Paracetamol+normal saline

Patients in Group 2 will receive 1000 mg IV paracetamol and 100 ml IV normal salines at the end of operation following by 1000 mg IV paracetamol and 100 ml IV normal salines every 6 hours up to 72 hours.

Group Type EXPERIMENTAL

Paracetamol injection and normal saline

Intervention Type DRUG

Use of paracetamol and normal saline to reduce morphine requirement inpatient after Total knee arthroplasty

Ibuprofen+normal saline

Patients in Group 3 will receive 800 mg IV ibuprofen and 100 ml IV normal salines at the end of operation following by 800 mg IV ibuprofen and 100 ml IV normal salines every 6 hours up to 72 hours.

Group Type EXPERIMENTAL

Ibuprofen Injection and normal saline

Intervention Type DRUG

Use of ibuprofen and normal saline to reduce morphine requirement inpatient after Total knee arthroplasty

Interventions

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Paracetamol injection and Ibuprofen injection

Use of combination acetaminophen and ibuprofen to reduce morphine requirement inpatient after Total knee arthroplasty

Intervention Type DRUG

Paracetamol injection and normal saline

Use of paracetamol and normal saline to reduce morphine requirement inpatient after Total knee arthroplasty

Intervention Type DRUG

Ibuprofen Injection and normal saline

Use of ibuprofen and normal saline to reduce morphine requirement inpatient after Total knee arthroplasty

Intervention Type DRUG

Other Intervention Names

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Paracetamol and Ibuprofen Paracetamol injection Ibuprofen injection

Eligibility Criteria

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Inclusion Criteria

* Adult patient with 20 \< BMI \< 30 kg/m2
* Adult patient with knee varus alignment 10-20°

Exclusion Criteria

* Impaired cardiac, liver, and/or renal function.
* History of substance abuse or chronic pain.
* Patients are known to be hypersensitive to any of the components of IV ibuprofen or IV paracetamol.
* Patients currently on anticoagulation medications.
* Inability to understand the requirements of the study or be unwilling to provide written informed consent (as evidenced by signature on an informed consent document approved by an Institutional Review Board) and agree to abide by the study restrictions.
Minimum Eligible Age

50 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Indonesia University

OTHER

Sponsor Role lead

Responsible Party

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Andri Maruli Tua Lubis

Head of Research Division RSCM

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Andri MT Lubis, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Fakultas Kedokteran Universitas Indonesia

Aida R Tantri, MD

Role: PRINCIPAL_INVESTIGATOR

Fakultas Kedokteran Universitas Indonesia

Ludwig AP Pontoh, MD

Role: PRINCIPAL_INVESTIGATOR

Fakultas Kedokteran Universitas Indonesia

Locations

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Fatmawati General Hospital

Jakarta, DKI Jakarta, Indonesia

Site Status

Cipto Mangunkusumo National General Hospital

Jakarta Pusat, DKI Jakarta, Indonesia

Site Status

Countries

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Indonesia

References

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American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012 Feb;116(2):248-73. doi: 10.1097/ALN.0b013e31823c1030. No abstract available.

Reference Type BACKGROUND
PMID: 22227789 (View on PubMed)

Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011 Aug;82(4):441-7. doi: 10.3109/17453674.2011.581264. Epub 2011 May 11.

Reference Type BACKGROUND
PMID: 21561303 (View on PubMed)

Barrington JW, Lovald ST, Ong KL, Watson HN, Emerson RH Jr. Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors. J Arthroplasty. 2016 Sep;31(9 Suppl):288-92. doi: 10.1016/j.arth.2016.05.002. Epub 2016 May 12.

Reference Type BACKGROUND
PMID: 27318410 (View on PubMed)

Oderda GM, Gan TJ, Johnson BH, Robinson SB. Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother. 2013 Mar;27(1):62-70. doi: 10.3109/15360288.2012.751956. Epub 2013 Jan 9.

Reference Type BACKGROUND
PMID: 23302094 (View on PubMed)

Sharma V, Morgan PM, Cheng EY. Factors influencing early rehabilitation after THA: a systematic review. Clin Orthop Relat Res. 2009 Jun;467(6):1400-11. doi: 10.1007/s11999-009-0750-9. Epub 2009 Mar 10.

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Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000 Jun 9;288(5472):1765-9. doi: 10.1126/science.288.5472.1765.

Reference Type BACKGROUND
PMID: 10846153 (View on PubMed)

Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006 Mar;14(3):126-35. doi: 10.5435/00124635-200603000-00003.

Reference Type BACKGROUND
PMID: 16520363 (View on PubMed)

Halawi MJ, Grant SA, Bolognesi MP. Multimodal Analgesia for Total Joint Arthroplasty. Orthopedics. 2015 Jul 1;38(7):e616-25. doi: 10.3928/01477447-20150701-61.

Reference Type BACKGROUND
PMID: 26186325 (View on PubMed)

Oderda G. Challenges in the management of acute postsurgical pain. Pharmacotherapy. 2012 Sep;32(9 Suppl):6S-11S. doi: 10.1002/j.1875-9114.2012.01177.x.

Reference Type BACKGROUND
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Barletta JF. Clinical and economic burden of opioid use for postsurgical pain: focus on ventilatory impairment and ileus. Pharmacotherapy. 2012 Sep;32(9 Suppl):12S-8S. doi: 10.1002/j.1875-9114.2012.01178.x.

Reference Type BACKGROUND
PMID: 22956490 (View on PubMed)

Buvanendran A. Multimodal Analgesia for Perioperative Pain Management: ASA Refresh Courses Anesthesiol. 2012;40(1):1-6.

Reference Type BACKGROUND

Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg. 2014 Oct;134(4 Suppl 2):85S-93S. doi: 10.1097/PRS.0000000000000671.

Reference Type BACKGROUND
PMID: 25255012 (View on PubMed)

Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev. 2013 Jun 24;2013(6):CD010210. doi: 10.1002/14651858.CD010210.pub2.

Reference Type BACKGROUND
PMID: 23794268 (View on PubMed)

Dahl JB, Nielsen RV, Wetterslev J, Nikolajsen L, Hamunen K, Kontinen VK, Hansen MS, Kjer JJ, Mathiesen O; Scandinavian Postoperative Pain Alliance (ScaPAlli). Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014 Nov;58(10):1165-81. doi: 10.1111/aas.12382. Epub 2014 Aug 14.

Reference Type BACKGROUND
PMID: 25124340 (View on PubMed)

Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010 Apr 1;110(4):1170-9. doi: 10.1213/ANE.0b013e3181cf9281. Epub 2010 Feb 8.

Reference Type BACKGROUND
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Thybo KH, Hagi-Pedersen D, Wetterslev J, Dahl JB, Schroder HM, Bulow HH, Bjorck JG, Mathiesen O. PANSAID - PAracetamol and NSAID in combination: study protocol for a randomised trial. Trials. 2017 Jan 10;18(1):11. doi: 10.1186/s13063-016-1749-7.

Reference Type BACKGROUND
PMID: 28069072 (View on PubMed)

McCartney CJ, Nelligan K. Postoperative pain management after total knee arthroplasty in elderly patients: treatment options. Drugs Aging. 2014 Feb;31(2):83-91. doi: 10.1007/s40266-013-0148-y.

Reference Type RESULT
PMID: 24399578 (View on PubMed)

Other Identifiers

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Pct-Ibf-FKUI

Identifier Type: -

Identifier Source: org_study_id