Management of Post-Tonsillectomy Pain in Pediatric Patients

NCT ID: NCT04551196

Last Updated: 2024-07-11

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-28

Study Completion Date

2022-11-10

Brief Summary

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Single-center, randomized, open-label, non-inferiority treatment pilot study to evaluate the effectiveness of a combined acetaminophen and ibuprofen regimen for treatment of post-operative tonsillectomy pain in the pediatric population. 100 children undergoing tonsillectomy will be randomized to receive either a combined acetaminophen and ibuprofen regimen dosed every 6 hours or an alternating regimen of acetaminophen and ibuprofen dosed every 3 hours.

Detailed Description

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Conditions

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Pain, Postoperative Tonsillar Hypertrophy Tonsillitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Single-center, randomized, open-label, non-inferiority treatment pilot study
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Open-label

Study Groups

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Alternating Regimen

A regimen of acetaminophen and ibuprofen alternating doses every 3 hours.

Group Type ACTIVE_COMPARATOR

Alternating Acetaminophen and Ibuprofen

Intervention Type DRUG

Subjects will alternate their post-operative acetaminophen and ibuprofen every 3 hours.

Combined Regimen

A regimen of acetaminophen and ibuprofen dosed together every 6 hours.

Group Type ACTIVE_COMPARATOR

Combined Acetaminophen and Ibuprofen

Intervention Type DRUG

Subjects will take their post-operative acetaminophen and ibuprofen together every 6 hours.

Interventions

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Alternating Acetaminophen and Ibuprofen

Subjects will alternate their post-operative acetaminophen and ibuprofen every 3 hours.

Intervention Type DRUG

Combined Acetaminophen and Ibuprofen

Subjects will take their post-operative acetaminophen and ibuprofen together every 6 hours.

Intervention Type DRUG

Other Intervention Names

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Alternating regimen Combined regimen

Eligibility Criteria

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Inclusion Criteria

* 4 to 17 years of age at time of enrollment
* Undergoing tonsillectomy with or without adenoidectomy
* Able to provide informed consent from parent or legal guardian
* Able to provide assent if subject is a minor of appropriate age

Exclusion Criteria

* Allergy to acetaminophen or ibuprofen
* Inability for study participant to cooperate with pain assessments
* Known pregnancy
* Any condition which would make the participant, in the opinion of the investigator, unsuitable for the study
Minimum Eligible Age

4 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Saint Louis Children's Hospital

St Louis, Missouri, United States

Site Status

Countries

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United States

References

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Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019 Feb;160(1_suppl):S1-S42. doi: 10.1177/0194599818801757.

Reference Type BACKGROUND
PMID: 30798778 (View on PubMed)

Ingram DG, Friedman NR. Toward Adenotonsillectomy in Children: A Review for the General Pediatrician. JAMA Pediatr. 2015 Dec;169(12):1155-61. doi: 10.1001/jamapediatrics.2015.2016.

Reference Type BACKGROUND
PMID: 26436644 (View on PubMed)

National Prospective Tonsillectomy Audit Final Report. Royal College of Surgeons https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/tonsillectomy-audit/

Reference Type BACKGROUND

Alvarez Palacios I, Gonzalez-Orus Alvarez-Morujo R, Alonso Martinez C, Ayala Mejias A, Arenas Britez O. Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique? Indian J Otolaryngol Head Neck Surg. 2017 Jun;69(2):187-193. doi: 10.1007/s12070-017-1058-9. Epub 2017 Jan 16.

Reference Type BACKGROUND
PMID: 28607888 (View on PubMed)

Lauder G, Emmott A. Confronting the challenges of effective pain management in children following tonsillectomy. Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1813-27. doi: 10.1016/j.ijporl.2014.08.011. Epub 2014 Aug 27.

Reference Type BACKGROUND
PMID: 25241379 (View on PubMed)

Tobias JD, Green TP, Cote CJ; SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE; COMMITTEE ON DRUGS. Codeine: Time to Say "No". Pediatrics. 2016 Oct;138(4):e20162396. doi: 10.1542/peds.2016-2396. Epub 2016 Sep 19.

Reference Type BACKGROUND
PMID: 27647717 (View on PubMed)

Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-Tafti S, Reid D, Maclean J, Koren G. Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015 Feb;135(2):307-13. doi: 10.1542/peds.2014-1906.

Reference Type BACKGROUND
PMID: 25624387 (View on PubMed)

Ismail Zaidan & Amanda Lent. Post-Tonsillectomy Pain in Children: The Postcodeine Era. US Pharm. 41, 31-34 (2016).

Reference Type BACKGROUND

D'Souza JN, Schmidt RJ, Xie L, Adelman JP, Nardone HC. Postoperative nonsteroidal anti-inflammatory drugs and risk of bleeding in pediatric intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2015 Sep;79(9):1472-6. doi: 10.1016/j.ijporl.2015.05.042. Epub 2015 Jul 2.

Reference Type BACKGROUND
PMID: 26164211 (View on PubMed)

Lewis SR, Nicholson A, Cardwell ME, Siviter G, Smith AF. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev. 2013 Jul 18;2013(7):CD003591. doi: 10.1002/14651858.CD003591.pub3.

Reference Type BACKGROUND
PMID: 23881651 (View on PubMed)

Merry AF, Gibbs RD, Edwards J, Ting GS, Frampton C, Davies E, Anderson BJ. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth. 2010 Jan;104(1):80-8. doi: 10.1093/bja/aep338.

Reference Type BACKGROUND
PMID: 20007794 (View on PubMed)

Miranda HF, Puig MM, Prieto JC, Pinardi G. Synergism between paracetamol and nonsteroidal anti-inflammatory drugs in experimental acute pain. Pain. 2006 Mar;121(1-2):22-8. doi: 10.1016/j.pain.2005.11.012. Epub 2006 Feb 9.

Reference Type BACKGROUND
PMID: 16480830 (View on PubMed)

Gardiner P, Dvorkin L. Promoting medication adherence in children. Am Fam Physician. 2006 Sep 1;74(5):793-8.

Reference Type BACKGROUND
PMID: 16970023 (View on PubMed)

Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet. 1996 Aug 10;348(9024):383-6. doi: 10.1016/s0140-6736(96)01073-2.

Reference Type BACKGROUND
PMID: 8709739 (View on PubMed)

Uitti JM, Salantera S, Laine MK, Tahtinen PA, Ruohola A. Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media? BMC Pediatr. 2018 Dec 20;18(1):392. doi: 10.1186/s12887-018-1361-y.

Reference Type BACKGROUND
PMID: 30572868 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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202002118

Identifier Type: -

Identifier Source: org_study_id

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