Post Operative Analgesia and Patient Satisfaction

NCT ID: NCT04976387

Last Updated: 2023-08-08

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

PHASE3

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-02

Study Completion Date

2023-05-11

Brief Summary

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To understand how patients perceive the quality of care they receive when given different post-operative analgesic medications. Specifically the investigators want to assess whether patients who receive non-opioid analgesia following surgery endorse appropriate quality and satisfaction with their care compared to those who receive opioid medication.

Detailed Description

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It is routine practice to give analgesic medication after any surgical procedure to provide adequate pain control for patients. However with the increase in abuse of opioid prescription medications, physicians have given a new emphasis to different pain regimens that aim to limit the use of opioid medications. The investigator's previous clinical trial demonstrated that for patients undergoing outpatient otolaryngology procedures, not only does Ibuprofen provide equally effective analgesia compared to opioid medication but it can also decrease overall opioid requirement.

In the current proposed study, the investigators wish to build on previous work. The investigators hypothesize that with the addition of Acetaminophen to Ibuprofen, patients undergoing outpatient otolaryngology procedures may not require opioid analgesia at all. While numerous studies corroborate these results, there is little information about patients' satisfaction with their care in light of a shifting emphasis on decreasing opioid prescription. The primary goal of the current study is to better understand patients' perception of care and level of satisfaction when given opioid versus non-opioid postoperative analgesia. If there is conflicting data with regards to patients reporting adequate pain control but poor satisfaction, then perhaps further public health intervention may be necessary to provide additional patient education to help re-establish appropriate and safe patient expectations for postsurgical analgesia.

Conditions

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Postoperative Pain Patient Satisfaction Analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized to one of three groups prior to surgery. Patients will be prescribed Hydrocodone/acetaminophen, Ibuprofen, and/or Acetaminophen. Patients assigned to treatment Group 1 will take the opioid medication for initial pain control followed by Ibuprofen if pain is not adequately controlled. Group 2 patients will take Ibuprofen for initial pain control followed by the opioid medication if pain is not adequately controlled. Group 3 patients will take Ibuprofen for initial pain control followed by Acetaminophen if pain is not adequately controlled.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Researchers will not be blinded during the process of recruitment of patients due to necessity of prescribing specific medications. Researchers will be blinded during outcome assessment and data analysis.

Study Groups

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Group 1: Hydrocodone/Acetaminophen and Ibuprofen

This group will take Hydrocodone/acetaminophen 5mg/325mg every 6 hours as needed for pain control

If pain is not controlled after 60 minutes then can take Ibuprofen 600mg every 6 hours as needed for additional pain control.

Group Type EXPERIMENTAL

Hydrocodone/Acetaminophen 5 Mg-325 Mg ORAL TABLET

Intervention Type DRUG

Patients are instructed to take Hydrocodone/acetaminophen 5 mg-325 mg oral tablets every 6 hours as needed for treatment of severe pain

Ibuprofen 600 mg

Intervention Type DRUG

Patients will take ibuprofen 600 mg every 6 hours as needed

Group 2: Ibuprofen and Hydrocodone/acetaminophen

This group will take Ibuprofen 600mg every 6 hours as needed for pain control

If pain is not controlled after 60 minutes then can take Hydrocodone/acetaminophen 5mg/325mg every 6 hours as needed for additional pain control.

Group Type EXPERIMENTAL

Hydrocodone/Acetaminophen 5 Mg-325 Mg ORAL TABLET

Intervention Type DRUG

Patients are instructed to take Hydrocodone/acetaminophen 5 mg-325 mg oral tablets every 6 hours as needed for treatment of severe pain

Ibuprofen 600 mg

Intervention Type DRUG

Patients will take ibuprofen 600 mg every 6 hours as needed

Group 3: Ibuprofen and Acetaminophen

This group will take Ibuprofen 600mg every 6 hours as needed for pain control

If pain is not controlled after 60 minutes then can take Acetaminophen 650mg every 6 hours as needed for additional pain control.

Group Type EXPERIMENTAL

Ibuprofen 600 mg

Intervention Type DRUG

Patients will take ibuprofen 600 mg every 6 hours as needed

Acetaminophen 650 MG

Intervention Type DRUG

Patients will take Tylenol 650mg every 6 hours as needed

Interventions

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Hydrocodone/Acetaminophen 5 Mg-325 Mg ORAL TABLET

Patients are instructed to take Hydrocodone/acetaminophen 5 mg-325 mg oral tablets every 6 hours as needed for treatment of severe pain

Intervention Type DRUG

Ibuprofen 600 mg

Patients will take ibuprofen 600 mg every 6 hours as needed

Intervention Type DRUG

Acetaminophen 650 MG

Patients will take Tylenol 650mg every 6 hours as needed

Intervention Type DRUG

Other Intervention Names

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Norco Advil, Motrin, NSAID Tylenol

Eligibility Criteria

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Inclusion Criteria

* Patients between the ages of 18 and 89 years of age
* Patients undergoing the following outpatient procedures at a LLUHS associated surgical facility:

* total or partial thyroidectomy
* parathyroidectomy
* parotidectomy
* submandibular gland excision
* neck mass excision
* facial mass excision
* MOHS defect repair
* excision of cutaneous lesions
* Other surgeries may qualify and will be assessed on a case by case basis.

Exclusion Criteria

* Patients under 18 years old or older than 89 years old
* Those allergic to Hydrocodone, Acetaminophen, or NSAIDS
* Patients who are pregnant
* Patients with chronic medical conditions including hepatic/renal disease that precludes their ability to utilize the study medications.
Minimum Eligible Age

18 Years

Maximum Eligible Age

89 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Loma Linda University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Khanh Nguyen, MD

Role: PRINCIPAL_INVESTIGATOR

Loma Linda University Health System

Locations

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Loma Linda University Health System

Loma Linda, California, United States

Site Status

Countries

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United States

References

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Wilson N, Kariisa M, Seth P, Smith H 4th, Davis NL. Drug and Opioid-Involved Overdose Deaths - United States, 2017-2018. MMWR Morb Mortal Wkly Rep. 2020 Mar 20;69(11):290-297. doi: 10.15585/mmwr.mm6911a4.

Reference Type BACKGROUND
PMID: 32191688 (View on PubMed)

Olfson M, Rossen LM, Wall MM, Houry D, Blanco C. Trends in Intentional and Unintentional Opioid Overdose Deaths in the United States, 2000-2017. JAMA. 2019 Dec 17;322(23):2340-2342. doi: 10.1001/jama.2019.16566.

Reference Type BACKGROUND
PMID: 31846008 (View on PubMed)

Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Netw Open. 2018 Jun 1;1(2):e180217. doi: 10.1001/jamanetworkopen.2018.0217.

Reference Type BACKGROUND
PMID: 30646062 (View on PubMed)

Pruitt LCC, Casazza GC, Newberry CI, Cardon R, Ramirez A, Krakovitz PR, Meier JD, Skarda DE. Opioid Prescribing and Use in Ambulatory Otolaryngology. Laryngoscope. 2020 Aug;130(8):1913-1921. doi: 10.1002/lary.28359. Epub 2019 Nov 27.

Reference Type BACKGROUND
PMID: 31774562 (View on PubMed)

Dang S, Duffy A, Li JC, Gandee Z, Rana T, Gunville B, Zhan T, Curry J, Luginbuhl A, Cottrill E, Cognetti D. Postoperative opioid-prescribing practices in otolaryngology: A multiphasic study. Laryngoscope. 2020 Mar;130(3):659-665. doi: 10.1002/lary.28101. Epub 2019 Jun 21.

Reference Type BACKGROUND
PMID: 31225905 (View on PubMed)

Foghsgaard S, Foghsgaard J, Homoe P. Early post-operative morbidity after superficial parotidectomy: a prospective study concerning pain and resumption of normal activity. Clin Otolaryngol. 2007 Feb;32(1):54-7. doi: 10.1111/j.1365-2273.2007.01315.x.

Reference Type BACKGROUND
PMID: 17298314 (View on PubMed)

Song CM, Ji YB, Bang HS, Kim KR, Kim H, Tae K. Postoperative Pain After Robotic Thyroidectomy by a Gasless Unilateral Axillo-Breast or Axillary Approach. Surg Laparosc Endosc Percutan Tech. 2015 Dec;25(6):478-82. doi: 10.1097/SLE.0000000000000204.

Reference Type BACKGROUND
PMID: 26422088 (View on PubMed)

Ilyas AM, Miller AJ, Graham JG, Matzon JL. Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone. J Hand Surg Am. 2018 Oct;43(10):913-919. doi: 10.1016/j.jhsa.2018.08.011.

Reference Type BACKGROUND
PMID: 30286851 (View on PubMed)

Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA. Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery. PLoS One. 2016 Jan 29;11(1):e0147972. doi: 10.1371/journal.pone.0147972. eCollection 2016.

Reference Type BACKGROUND
PMID: 26824844 (View on PubMed)

Wu AW, Walgama ES, Genc E, Ting JY, Illing EA, Shipchandler TZ, Higgins TS. Multicenter study on the effect of nonsteroidal anti-inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery. Int Forum Allergy Rhinol. 2020 Apr;10(4):489-495. doi: 10.1002/alr.22506. Epub 2019 Dec 13.

Reference Type BACKGROUND
PMID: 31834679 (View on PubMed)

Papoian V, Handy KG, Villano AM, Tolentino RA, Hassanein MT, Nosanov LS, Felger EA. Randomized control trial of opioid- versus nonopioid-based analgesia after thyroidectomy. Surgery. 2020 Jun;167(6):957-961. doi: 10.1016/j.surg.2020.01.011. Epub 2020 Feb 29.

Reference Type BACKGROUND
PMID: 32127178 (View on PubMed)

Nguyen KK, Liu YF, Chang C, Park JJ, Kim CH, Hondorp B, Vuong C, Xu H, Crawley BK, Simental AA, Church CA, Inman JC. A Randomized Single-Blinded Trial of Ibuprofen- versus Opioid-Based Primary Analgesic Therapy in Outpatient Otolaryngology Surgery. Otolaryngol Head Neck Surg. 2019 May;160(5):839-846. doi: 10.1177/0194599819832528. Epub 2019 Mar 5.

Reference Type BACKGROUND
PMID: 30832548 (View on PubMed)

Gostian AO, Loeser J, Tholen C, Wolber P, Otte M, Schwarz D, Heindl LM, Balk M, Gostian M. Postoperative pain after tonsillectomy - the value of standardized analgesic treatment protocols. Auris Nasus Larynx. 2020 Dec;47(6):1009-1017. doi: 10.1016/j.anl.2020.05.011. Epub 2020 Jun 12.

Reference Type BACKGROUND
PMID: 32536501 (View on PubMed)

Hallway A, Vu J, Lee J, Palazzolo W, Waljee J, Brummett C, Englesbe M, Howard R. Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway. J Am Coll Surg. 2019 Sep;229(3):316-322. doi: 10.1016/j.jamcollsurg.2019.04.020. Epub 2019 May 30.

Reference Type BACKGROUND
PMID: 31154092 (View on PubMed)

Other Identifiers

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52004443

Identifier Type: -

Identifier Source: org_study_id

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