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CompletedNCT02869321ANTALGIPUpdated May 13, 2019

Analgesic Efficacy of Transmucosal Fentanyl for Breakthrough Pain Caused by Interventional Gastrostomy

A Phase 4 interventional study of Fentanyl and Morphine Sulfate in Gastrostomy, Breakthrough Pain and Upper Aerodigestive Tract Neoplasms, sponsored by Central Hospital, Nancy, France. Completed at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-05-13.

Sponsored by Central Hospital, Nancy, France · Phase 4, Interventional, and Supportive care

Phase
Phase 4
Study type
Interventional
Enrollment
20
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Patients with Head \& Neck Squamous Cell Carcinoma often need a gastrostomy. It can be performed with a radiological approach. This procedure is usually not performed under general anesthesia, but local anesthesia is not sufficient to counteract pain due to gastric insufflation and incision of the abdominal wall. Standard analgesic treatments are usually not well-fitted due to onset of action or route of administration. An alternative solution could be fentanyl nasal spray, a treatment with a fast onset of action and with easy use allowing repetition if needed, during the procedure.

The purpose of this study is to compare analgesic efficacy of nasal instillation of PECFENT® to usually administered morphinic analgesic treatment with fast onset of action (ORAMORPH®), in radiologic percutaneous gastrostomy tube placement:

  • during the procedure
  • following the procedure (measured by Visual Analog Scale (VAS) for Pain at 15 min, 30 min, 1 hour, 2 hours, 3 hours, 4 hours, 6 hours and 12 hours after procedure).

Secondary purposes are to compare easiness of 2 treatments and their adverse effects.

02

Conditions studied

  • Gastrostomy
  • Breakthrough Pain
  • Upper Aerodigestive Tract Neoplasms
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patient care for cancer of the upper aerodigestive tract (except sinonasal)
  • > 18, all weights, all sexes
  • Under balanced background opioid treatment since longer than 7 days (VAS \< 5)
  • Needing a radiologic gastrostomy under local anesthesia
  • Informed consent
  • Affiliation to social security plan
  • Preliminary medical examination

Exclusion criteria

Exclusion Criteria:

  • Non balanced morphinic treatment : modification of analgesic treatment during 7 previous days
  • Radiotherapy of nasal fossae/sinus
  • Technical impossibility or contraindication to PECFENT®, ORAMORPH® and associated drugs
  • Impossibility of pain evaluation by patient
  • Belonging to protected class: pregnant or breastfeeding woman, person deprived of liberty for judiciary or administrative decision, under-18, person under legal protection or incapable of giving consent, person in life-and-death emergency incapable of giving a preliminary consent
04

Study design

Phase
Phase 4
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
20 participants (actual)

Study arms

  • Experimental
    Fentanyl

    Administration of Morphine Sulfate Placebo and Fentanyl 1. Morphine Sulfate Placebo: oral solution administered through nasogastric tube, 10% of daily dose of morphine of background treatment, 1 hour before gastrostomy + 2. Fentanyl: nasal spray solution, 100 µg pulverisation, 15 min before gastrostomy, if not efficacy second dose after 15 min during gastrostomy Administration 1+2 if pain after 4 hours from gastrostomy

    Drug: Fentanyl · Drug: Morphine Sulfate placebo · Procedure: Gastrostomy

  • Placebo comparator
    Morphine Sulfate

    Administration of Morphine Sulfate and Fentanyl Placebo 1. Morphine Sulfate: oral solution administered through nasogastric tube, 10% of daily dose of morphine of background treatment, 1 hour before gastrostomy + 2. Fentanyl Placebo: nasal spray solution, 100 µg pulverisation, 15 min before gastrostomy, if not efficacy second dose after 15 min during gastrostomy Administration 1+2 if pain after 4 hours from gastrostomy

    Drug: Morphine Sulfate · Drug: Fentanyl placebo · Procedure: Gastrostomy

Interventions

  • DrugFentanyl

    Also known as: PECFENT®

  • DrugMorphine Sulfate

    Also known as: ORAMORPH®

  • DrugFentanyl placebo
  • DrugMorphine Sulfate placebo
  • ProcedureGastrostomy
05

What researchers measure

Primary outcomes

  1. Intensity of breakthrough pain during the gastrostomy

    Pain measured by VAS

    Time frame: during gastrostomy

  2. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 15 min after gastrostomy

  3. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 30 min after gastrostomy

  4. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 1 hour after gastrostomy

  5. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 2 hours after gastrostomy

  6. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 3 hours after gastrostomy

  7. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 4 hours after gastrostomy

  8. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 6 hours after gastrostomy

  9. Intensity of pain following the gastrostomy

    Pain measured by VAS

    Time frame: 12 hours after gastrostomy

  10. Necessity of a second analgesic treatment after gastrostomy

    in case of Pain VAS \>4

    Time frame: up to 12 hours from gastrostomy

Secondary outcomes

  1. Evaluation of satisfaction of patient with analgesic efficacy

    Questionnaire

    Time frame: up to 1 day from gastrostomy

  2. Evaluation of satisfaction of staff with analgesic efficacy and easiness to use of treatments

    Questionnaire

    Time frame: up to 1 day from gastrostomy

  3. Compliance of times of administration of treatments with the procedure

    Time frame: day 0

  4. Comparison of adverse effects of administered drugs

    Time frame: up to 24 hours post gastrostomy

06

Study locations

1 site
  • Service ORL - CHU NANCY
    Nancy, France
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT02869321
Lead sponsor
Central Hospital, Nancy, France
Responsible party
Sponsor
First posted
Aug 16, 2016
Start date
May 2015
Primary completion
May 2018
Completion
May 2018
Last update
May 13, 2019

Study contacts

Patrice GALLET
principal investigator · Service ORL - CHU NANCY - France

Oversight

Data monitoring committee
Yes
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