Pain control with spinal morphine combined with spinal anesthesia before orthopedic surgery

ISRCTN ISRCTN10993984
DOI https://doi.org/10.1186/ISRCTN10993984
Secondary identifying numbers PH7
Submission date
25/03/2018
Registration date
16/05/2018
Last edited
24/04/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
Pain management in El Salvador is underestimated; thousands of patients suffer intense pain after surgery, without any adequate protocol for painkillers (analgesics) based on intensity. Among Latin American countries, morphine sulfate is the painkiller with the lowest consumption rate for pain management, exposing the breach of patient’s right for pain relief.
This study aims to determine the effectiveness and safety of combining painkiller medication (multimodal analgesia) using preventative doses, combined with pain control after surgery.

Who can participate?
Adults aged 18 or over undergoing elective orthopedic surgery requiring spinal anesthesia

What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group receive two painkillers (spinal morphine and bupivacaine) in combination prior to surgery. Those in the second group only receive one (bupivacaine). After surgery, all participants receive one drug (Ketorolac) to reduce swelling (anti-inflammatory). They are followed up for 24 hours, rating pain with a verbal scale and administered an appropriate drug for pain level based on guidance from the World Health Organisation.

What are the possible benefits and risks of participating?
Participants may potentially benefit from pain control in the first 24 hours after surgery, with individualized pain assessment and treatment. There is no monetary gain for participation in the study. Participants may be at risk of experiencing itchiness, difficulty urinating, nausea, vomiting and in very rare cases difficulty breathing.

Where is the study run from?
San Rafael Hospital (El Salvador)

When is the study starting and how long is it expected to run for?
June 2014 – November 2014

Who is funding the study?
Dr. Jose Matias Delgado University, affiliate of San Rafael Hospital (El Salvador)

Who is the main contact?
Dr Carlos Salazar (Scientific)
csalaz8@uic.edu

Contact information

Dr Carlos Salazar
Scientific

San Rafael Hospital
Carr. Panamericana 15
Santa Tecla
60640
El Salvador

ORCiD logoORCID ID 0000-0003-1758-3567
Phone +503 2594 4000
Email csalaz8@uic.edu
Dr Carlos Salazar
Scientific

Louis A. Weiss Memorial Hospital affiliate of the University of Illinois at Chicago
4646 North Marine Drive
Chicago
Illinois
Chicago
60640
United States of America

ORCiD logoORCID ID 0000-0003-1758-3567
Phone +1 773 878 8700
Email csalaz8@uic.edu

Study information

Study designPhase IV single center double blind randomized clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet ISRCTN10993984_PIS_v1_14May18.pdf
Scientific titleMultimodal analgesia using 100 μg of preemptive intrathecal morphine sulfate combined with hyperbaric bupivacaine for postoperative pain control in orthopedic surgery: a double blind randomized clinical trial
Study objectivesMultimodal analgesia using a single dose of preemptive intrathecal morphine sulfate added to hyperbaric bupivacaine for spinal anesthesia is more effective compared to postoperative opioid and non-opioid pain control after orthopedic surgery
Ethics approval(s)San Rafael Hospital Investigation Ethics Committee, 26/06/2013, ref: 4570
Health condition(s) or problem(s) studiedPain control
InterventionParticipants are randomly allocated to the experimental group or control. Those in the experimental group (M1) receive 100 μg of intrathecal morphine sulfate combined with 1-2 mL of hyperbaric bupivacaine for spinal anesthesia on the preoperative setting. The control group (M0) receive 1-2 mL of hyperbaric bupivacaine alone.
Both groups (M1) and (M0) receive 30 mg of Ketorolac I.V. for anti-inflammatory effect on the time of discharge from the recovery room, and they are followed up to 24 hours in the orthopedic department, evaluating episodes of pain intensity with Verbal Numerical Rating Scale (VNRS) and administrating for every single pain episode a dose of Paracetamol 500-1000 mg PO, Tramadol 50 mg PO, Ketorolac 30 mg I.V. or 60 mg I.M., Diclofenac 75 mg I.M. or Meperidine 50 mg I.V. based on WHO's analgesic ladder.
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase IV
Drug / device / biological / vaccine name(s)
Primary outcome measurePain is assessed by the following:
1.1. Individual interviews before discharge from the Post-Anesthesia Care Unit (baseline) and every single episode of pain during the first 24 hour post-operative period
1.2. Time to appearance of first episode of pain in the 24 hour post-operative period
1.3. Intensity of pain was measured using the verbal numeric rating scale (VNRS)
1.4. Frequency of pain episodes is measured throughout the 24 hour post-operative period
Secondary outcome measures1. Type and quantity of analgesics needed is measured according the WHO's analgesic ladder throughout the 24 hour post operative period
2. Frequency of episodes of pruritus, nausea and vomiting, respiratory depression, and urinary retention are measured throughout the 24 hour post operative period
3. Patient satisfaction is evaluated using using a questionnaire based on the Likert scale in the first 24 hours
Overall study start date15/01/2013
Completion date28/11/2014

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants80 patients
Key inclusion criteria1. 18 years and older
2. ASA I and II
3. Lower limb fracture
4. Elective orthopedic surgery
5. Spinal anesthesia
Key exclusion criteria1. <18 years-old
2. ASA > II
3. Documented allergy to opioids or non opioid analgesics
4. Emergency surgery
5. BMI >35
6. Asthma
7. Obstructive sleep apnea
8. Chronic use of opioids defined as more than > 2 weeks
9. Pregnancy
10. History of drug abuse or alcohol use
11. History of psychiatric condition
Date of first enrolment01/04/2014
Date of final enrolment15/10/2014

Locations

Countries of recruitment

  • El Salvador

Study participating centre

San Rafael Hospital
Santa Tecla
0000
El Salvador

Sponsor information

San Rafael Hospital
Hospital/treatment centre

Carr. Panamericana 15
Santa Tecla
0000
El Salvador

Funders

Funder type

University/education

Dr. Jose Matias Delgado University

No information available

Results and Publications

Intention to publish date10/05/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planPlanned publication in a high impact peer reviewed journal.
IPD sharing planThe datasets generated during and/or analysed during the current study are/will be available upon request from Carlos Salazar, csalaz8@uic.edu

Additional documentation:
Protocol available at: http://www.redicces.org.sv/jspui/handle/10972/1879

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Participant information sheet version v1 14/05/2018 17/05/2018 No Yes

Additional files

ISRCTN10993984_PIS_v1_14May18.pdf
Uploaded 17/05/2018

Editorial Notes

24/04/2019: Internal review.
17/05/2018: Contact details for the principal investigator were added and the participant information sheet was uploaded.