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CompletedNCT03626753Updated Aug 15, 2018

Comparison of Two Routes of Administration of a Multimodal Analgesic Protocol in Postoperative Cesarean Section

A Phase 2/3 interventional study of Nefopam 20 MG/ML and "Nefopam (Acupan)" 20 MG/ML Injectable Solution in Cesarean Section; Complications, Wound, Infection (Following Delivery), Postoperative Pain and Spinal Anaesthesia During the Puerperium, sponsored by Centre de Maternité de Monastir. Completed at 1 site in Tunisia. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-08-15.

Sponsored by Centre de Maternité de Monastir · Phase 2/3, Interventional, and Treatment

Phase
Phase 2/3
Study type
Interventional
Enrollment
200
Allocation
Randomized
Ages
18 Years and older
Sex
Female
01

Study summary

Many drugs with various mechanisms of action are used for postcaesarean pain relief. Although the response to pain relief is sometimes believed to be individual, it is very important to establish the most effective with the least adverse effects type of oral analgesia for women after caesarean section. Optimal pain control post-caesarean section will benefit not only the mother and her baby, but also a healthcare system. Optimal pain control may shorten the time spent in hospital after caesarean section and, therefore, reduce healthcare costs.

Read the detailed description

Pain after cesarean section (CS), usually described as strong, is an obstacle to good mother-child interaction and post-operative rehabilitation. Its management is important for a quick recovery and allow the mother to take care and link with her newborn. Currently, intrathecal opioids are the most commonly used technique and provide the foundation for post-cesarean analgesia. This technique combined with multimodal analgesia reduces the doses of morphine consumed, including these side effects. Spinal anesthesia is the standard anesthetic technique for caesarean section; it offers several advantages including the possibility of prescribing oral analgesics. An ideal analgesic protocol is one that is simple to implement, cost-effective, and has minimal impact on the work staff. It would have a good safety profile, a low incidence of side effects and complications, and respond to wide inter-patient variability. It relieves the mother of high quality pain while having minimal interference with her, newborn care and anesthesia while allowing safe breastfeeding.

The aim of this work is to compare the quality of an multimodal oral analgesia with intravenous analgesia and to demonstrate non-inferiority of the oral route pain relieve in postoperative caesarean section period. The secondary objectives was to evaluate the maternal tolerance of the drugs (piroxicam, nefopam, paracetamol) used postoperatively of a caesarean section.

02

Conditions studied

  • Cesarean Section; Complications, Wound, Infection (Following Delivery)
  • Postoperative Pain
  • Spinal Anaesthesia During the Puerperium

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Keywords

  • Pain
  • multimodal
  • analgesia
  • postoperative
  • cesarean section
  • obstetric
  • Agents
  • Physiological effects of drugs
  • opioid
  • Paracetamol
  • NSAIDs
03

Who can participate

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

Inclusion criteria

  • Pregnant in singleton pregnancy with gestational age > 34 weeks
  • American society of anesthesiologists (ASA) physical status I-II.

Exclusion criteria

Exclusion Criteria:

  • history of gastrointestinal disorders predisposing to bleeding disorders such as ulcerative colitis,
  • Crohn's disease,
  • gastrointestinal cancers or diverticulitis,
  • an active peptic ulcer,
  • an inflammatory gastrointestinal disorder or a gastrointestinal haemorrhage,
  • parturients who present preeclampsia,
  • premature delivery (\<32 weeks),
  • constitutional or acquired coagulopathy,
  • An antecedent of hemorrhage of the delivery,
  • a hemorrhagic complication postoperatively,
  • Anemia (hemoglobin less than 8g / 100ml),
  • conversion of spinal anesthesia into general anesthesia,
  • women with severe medical conditions: renal failure (preoperative creatinine clearance \<30ml / min), heart or liver failure.
04

Study design

Phase
Phase 2 / Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Investigator)
Enrollment
200 participants (actual)

Study arms

  • Active comparator
    Oral Group

    received in post operative period oral analgesia ( "nefopam (Acupan)" 20mg/6h, "piroxicam (piroxan)" 40mg/24h," Acetaminophen (paracetamol)" 1g/6h)

    Drug: Nefopam 20 MG/ML · Drug: "Acetaminophen, (paracetamol)" 500Mg Tab · Drug: (Piroxicam "piroxan") 20 MG Oral Tablet

  • Active comparator
    Intravenous group

    received in post operative period intravenous analgesia ( "nefopam (Acupan)" 20mg/6h, "piroxicam (piroxan)" 40mg/24h," Acetaminophen (paracetamol)" 1g/6h)

    Drug: "Nefopam (Acupan)" 20 MG/ML Injectable Solution · Drug: (Acetaminophen "paracetamol") IV Soln 10 MG/ML · Drug: (Piroxicam "piroxan") 20Mg/1mL Injection

Interventions

  • DrugNefopam 20 MG/ML

    given by Oral route the dose of 20mg every 6 hours.

    Also known as: 2 ampoule

  • Drug"Nefopam (Acupan)" 20 MG/ML Injectable Solution

    given by intravenous route at the dose of 20mg every 6 hours.

    Also known as: 2 ampoule

  • Drug"Acetaminophen, (paracetamol)" 500Mg Tab

    2 tablets of "Acetaminophen (paracetamol)" 500Mg Tab administrated orally every 6 hours.

    Also known as: 2 tablets

  • Drug(Acetaminophen "paracetamol") IV Soln 10 MG/ML

    Acetaminophen IV Soln 10 MG/ML, 1g paracetamol administrated intravenously every 6 hours.

    Also known as: 1 ampoule: 1g

  • Drug(Piroxicam "piroxan") 20 MG Oral Tablet

    2 tablets of "piroxicam (piroxan)" administrated orally once per 24 hours.

    Also known as: 2 tablets

  • Drug(Piroxicam "piroxan") 20Mg/1mL Injection

    2 ampoules of (piroxicam "piroxan") administrated intravenously once per 24 hours.

    Also known as: 2 ampoules

05

What researchers measure

Primary outcomes

  1. Visual Analogue Scale (VAS) pain

    from 0 - 10 (with 0 being no pain and 10 being the most severe pain imaginable) at rest and coughing or mobilization

    Time frame: 24 hours postoperative

Secondary outcomes

  1. morphine consumption

    morphine consumption

    Time frame: 24 hours postoperative

  2. sides effects

    the occurrence of any undesirable effects related to the administration of any of the 3 drugs (nausea, vomiting, diarrhea, malaise, hypotension, sweating, convulsion, dryness of the mouth, tachycardia, palpitations, vertigo, allergic reactions)

    Time frame: 24 hours postoperative

  3. postoperative complications

    The occurrence of a postoperative complication (postpartum haemorrhage, blood transfusion, hysterectomy, etc).

    Time frame: 24 hours post operative

06

Study locations

1 site
  • Centre de Maternité de Monastir
    Monastir, 5000, Tunisia
07

References and documents

Publications

  • Mahajan L, Mittal V, Gupta R, Chhabra H, Vidhan J, Kaur A. Study to Compare the Effect of Oral, Rectal, and Intravenous Infusion of Paracetamol for Postoperative Analgesia in Women Undergoing Cesarean Section Under Spinal Anesthesia. Anesth Essays Res. 2017 Jul-Sep;11(3):594-598. doi: 10.4103/0259-1162.206872. PubMed 28928554 ↗
  • Mkontwana N, Novikova N. Oral analgesia for relieving post-caesarean pain. Cochrane Database Syst Rev. 2015 Mar 29;2015(3):CD010450. doi: 10.1002/14651858.CD010450.pub2. PubMed 25821010 ↗

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03626753
Lead sponsor
Centre de Maternité de Monastir
Responsible party
Fethi Jebali (Medical doctor, clinical professor of Anesthesiology and intensive care medecine, Centre de Maternité de Monastir) — Principal investigator
First posted
Aug 13, 2018
Start date
Jan 1, 2015
Primary completion
Jun 30, 2015
Completion
Jun 30, 2015
Last update
Aug 15, 2018

Oversight

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

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