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CompletedNCT03469310Updated May 11, 2021

Minimizing Narcotic Analgesics After Endocrine Surgery

A Phase 4 interventional study of Acetaminophen 500Mg Cap and Tylenol #3 Oral Tablet in Thyroid Cancer, Thyroid Nodule and Thyroid Neoplasms, sponsored by Minerva A Romero Arenas. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-05-11.

Sponsored by Minerva A Romero Arenas · Phase 4, Interventional, and Supportive care

Phase
Phase 4
Study type
Interventional
Enrollment
126
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This research is being done to better understand and test if the investigators can minimize narcotic medication for controlling pain after thyroid or parathyroid surgery. This research will be performed at Doctors Hospital At Renaissance in the investigators clinic and the perioperative area.

Participants will be randomly chosen to receive one of two options for pain management that the investigators are already using in the care of patients after surgery. One option includes a narcotic medication and one option includes a non-narcotic and a narcotic as needed.

Participants will be asked to complete a form about the level of pain and how much pain medication was needed after surgery in the hospital and while at home. Participants will not have to do any additional visits to participate in this study. The investigators will obtain the research materials at the same time as the usual care visits around the participants' surgery.

Read the detailed description

A study team member will give the participant a copy of the informed consent form to read. Participants will have a chance to ask questions about the study before agreeing to participate. If participants agree, they will be randomly chosen to receive one of two options for pain management that the investigators are already using in the care of patients (option 1: Tylenol (also known as acetaminophen) with tramadol if needed, or option 2: Tylenol #3 as needed) after surgery.

Participants will be asked to complete a form about the level of pain and how much pain medication was needed after surgery in the hospital and while at home. Participants will come to the GME General Surgery Center approximately one week after surgery for a post-operative visit so that the investigators can see how much pain medication was used and how much pain the participant had in the first few days after surgery.

Participants will not have to do any additional visits to participate in this study. The investigators will obtain the research materials at the same time as the usual care visits around the participants' surgery. It should take approximately 2 minutes each day to complete.

02

Conditions studied

  • Thyroid Cancer
  • Thyroid Nodule
  • Thyroid Neoplasms
  • Thyroid Goitre
  • Thyroid Diseases
  • Parathyroid Diseases
  • Parathyroid Adenoma
  • Parathyroid Hyperplasia

Keywords

  • endocrine surgery
  • opioid addiction
  • pain management
  • analgesia
03

Who can participate

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

Inclusion criteria

  1. Adult patients 18 years of age or older,
  2. Who are undergoing thyroid or parathyroid surgery at DHR by an Endocrine Surgery faculty member,
  3. Provide informed consent to participate in the study in English or Spanish,
  4. Patients will be included if they are discharged the same day or on postoperative day 1,
  5. Patients who undergo central lymphadenectomy will be included,
  6. Patients who undergo two operations within a 2-week period (for example a thyroid lobectomy followed by subsequent completion thyroidectomy) will only have the postoperative narcotic requirements following the initial operation included for the study analysis.
  7. Patients who have a complication, such as seroma or hematoma, requiring return to the operating room within 48 hours will be included in the study for the initial operation only.

Exclusion criteria

Exclusion Criteria:

  1. Patients who undergo lateral neck lymph node dissection will be excluded from the study due to the extent of the operation requiring a different analgesic regimen;
  2. Patients allergic to any of the study drugs will be ineligible;
  3. Patients who undergo two operations within a 2-week period (for example a thyroid lobectomy followed by subsequent completion thyroidectomy) will only have the initial operation included for the study analysis.
  4. Patients with a formal diagnosis of hepatic failure will be ineligible
  5. Patients with any diagnosis of chronic pain requiring treatment with ongoing narcotic regimen will be ineligible
04

Study design

Phase
Phase 4
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
126 participants (actual)

Study arms

  • Experimental
    Acetaminophen

    Tylenol (also known as acetaminophen) 1000mg every 6 hours for 3 days and tramadol 50 mg every 6 hours as needed for moderate to severe pain

    Drug: Acetaminophen 500Mg Cap · Drug: Tramadol

  • Active comparator
    Codeine Acetaminophen

    Tylenol #3 (codeine-acetaminophen) 1 tab every 4 hours or 2 tabs every 6 hours as needed for pain

    Drug: Tylenol #3 Oral Tablet

Interventions

  • DrugAcetaminophen 500Mg Cap

    non-narcotic medication first with narcotic as second choice

    Also known as: Tylenol

  • DrugTylenol #3 Oral Tablet

    Narcotic medication first

    Also known as: codeine-acetaminophen

  • DrugTramadol

    non-narcotic medication first with narcotic as second choice

05

What researchers measure

Primary outcomes

  1. Staged narcotic analgesic regimen is non-inferior to narcotics in controlling pain

    Patient pain scores will be logged using Wong-Baker FACES pain rating scale (range 0-10) and scores will be assessed for differences between the study arms

    Time frame: Patient will report pain score up to two weeks after surgery

Secondary outcomes

  1. Is there a difference in the duration of postoperative pain requiring medication

    The number of days after surgery that participants required pain medications will be counted and assessed for difference between the study arms

    Time frame: Patient will report medication requirements up to two weeks after surgery

  2. Is there a difference in the medication requirement

    The type and quantity of pain medications used after surgery will be counted and assessed for difference between the study arms

    Time frame: Patient will report medication requirements up to two weeks after surgery

  3. Staged regimen cross over to narcotic

    The type and quantity of pain medications used after surgery will be counted and number of patients requiring cross over will be assessed

    Time frame: Patient will report medication requirements up to two weeks after surgery

06

Study locations

1 site
  • GME General Surgery Clinic
    Edinburg, Texas 78539, United States
07

References and documents

Publications

  • Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(50-51):1445-1452. doi: 10.15585/mmwr.mm655051e1. PubMed 28033313 ↗
  • Waljee JF, Li L, Brummett CM, Englesbe MJ. Iatrogenic Opioid Dependence in the United States: Are Surgeons the Gatekeepers? Ann Surg. 2017 Apr;265(4):728-730. doi: 10.1097/SLA.0000000000001904. No abstract available. PubMed 27429023 ↗
  • Jiang X, Orton M, Feng R, Hossain E, Malhotra NR, Zager EL, Liu R. Chronic Opioid Usage in Surgical Patients in a Large Academic Center. Ann Surg. 2017 Apr;265(4):722-727. doi: 10.1097/SLA.0000000000001780. PubMed 27163960 ↗
  • Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016 Mar 18;65(1):1-49. doi: 10.15585/mmwr.rr6501e1. Erratum In: MMWR Recomm Rep. 2016;65(11):295. PubMed 26987082 ↗
  • Scully RE, Schoenfeld AJ, Jiang W, Lipsitz S, Chaudhary MA, Learn PA, Koehlmoos T, Haider AH, Nguyen LL. Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures. JAMA Surg. 2018 Jan 1;153(1):37-43. doi: 10.1001/jamasurg.2017.3132. PubMed 28973092 ↗
  • Rogers SO Jr. Addressing Variability in Opioid Prescribing. JAMA Surg. 2018 Jan 1;153(1):43. doi: 10.1001/jamasurg.2017.3166. No abstract available. PubMed 28973361 ↗

Individual participant data

Plan to share: Yes — De-identified information only will be made available to interested researchers.

Supporting information: Study protocol, Icf

08

Registry details

Key details

Study ID
NCT03469310
Lead sponsor
Minerva A Romero Arenas
Responsible party
Minerva A Romero Arenas (Principal Investigator, DHR Health Institute for Research and Development) — Sponsor-investigator
First posted
Mar 19, 2018
Start date
Mar 9, 2018
Primary completion
Dec 21, 2019
Completion
Oct 2, 2020
Last update
May 11, 2021

Study contacts

Minerva A Romero Arenas, MD, MPH
principal investigator · GME General Surgery
Samuel K Snyder, MD
principal investigator · GME General Surgery
Henry A Reinhart, MD
principal investigator · GME General Surgery

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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