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HyperalgesiaPhase 4NCT03450161

Hyperalgesia, Persistent Pain, and Fentanyl Dosing in On-Pump Coronary Artery Bypass Grafting

A Phase 4 study testing Fentanyl dosing schemes in people with Hyperalgesia and Opioid Use, run by University Hospital, Ghent at 1 site in Belgium.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Randomized, double-blinded, three arm study in adult patients undergoing first time coronary artery bypass grafting (CABG) surgery with median sternotomy. The investigators will examine the effects of three fentanyl dosing schemes (high-dose bolus, low-dose bolus, continuous dose) on the area of hyperalgesia and… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hyperalgesia, Opioid Use, Pain, Postoperative
What is being tested?
Fentanyl dosing schemes
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
1 siteBelgium
Study dates
14 May 2018to 9 Jan 2021
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Consenting patients aged ≥18 years
  • Undergoing first-time, elective, on-pump CABG surgery with median sternotomy and central cannulation.

Who cannot join

  • Documentation of preexisting chronic pain as per electronic record
  • Use of opioids in the last 30 days or history/documentation of opioid abuse as per electronic record
  • BMI > 35kg/m2 or history of obstructive sleep apnea syndrome
  • Patients with renal failure (clearance < 30 ml/min)
  • Neuraxial anesthesia
  • Pregnancy
Show all 9Show fewer
  • Planned wound infiltration with local anesthetics
  • Known drug allergies or intolerance to fentanyl or other opioids
  • Expected to be unable to understand pinprick/allodynia testing / follow-up questions

Trial locations and contacts

1 site in 1 country.

Belgium1 site
  • University Hospital Ghent

    Ghent, Oost-Vlaanderen, 9000

Other trials in Belgium

About this study

Randomized, double-blinded, three arm study in adult patients undergoing first time coronary artery bypass grafting (CABG) surgery with median sternotomy. The investigators will examine the effects of three fentanyl dosing schemes (high-dose bolus, low-dose bolus, continuous dose) on the area of hyperalgesia and allodynia at 24 and 48h as well as on persisting pain at 3, 6, and 12 months. Additionally, the investigators will measure fentanyl concentrations throughout anesthesia.

Read the detailed description

A prospective, randomized, double-blinded (patient, anesthesiologist, assessor) clinical study. This study will examine three different clinically used application schemes of fentanyl, an opioid used as the standard of care in routine practice. Patients will be randomized to receive one of the following three treatment arms for anesthesia maintenance (pre-sternotomy):

  1. High-dose fentanyl bolus (20 µg/kg of body weight [BW]; e.g. 70kg 1400 µg or 1.4mg)
  2. Low-dose fentanyl bolus (3 µg/kg BW; e.g. 70kg 210 µg or 0.2mg)
  3. Continuous fentanyl application by Shibutani scheme This study will include data from 69 adult patients (23 per arm) undergoing first time, elective, on-pump CABG surgery with median sternotomy and central cannulation. Following randomization by the sealed envelope technique, fentanyl kits will be drawn up by an anesthesiologist not involved in patient care or outcome assessment. Patients with preexisting chronic pain, opioids in the last 30 days, a BMI>36kg/m2, sleep apnoea, renal failure (clearance <30ml/min), with neuraxial anesthesia, pregnant, with planned wound infiltration, known allergies/intolerance to opioids, and unable to understand pin-prick testing will be excluded. At induction, all patients will receive a standard 3 µg/kg bolus of fentanyl (not study medication, but rather standard of care). 5 minutes prior to sternotomy, the patient will receive analgesia maintenance (one of the three fentanyl study arms). Clinicians will at all times be able to administer a bolus of fentanyl on a perceived "as needed" basis (not study medication, but rather standard of care). The primary objective of this trial is to assess whether or not different intraoperative dosing schemes of fentanyl during on-pump CABG surgery influence the area of hyperalgesia as measured by sternal pin-prick testing on the first postoperative day. As the mechanisms causing opioid-induced analgesia are poorly understood but appear to be dosis-related, the investigators will examine 3 clinically used fentanyl application schemes in cardiac surgery: 1) a high-dose bolus group, 2) a low-dose bolus group, and 3) a low-dose continuous infusion group. [i.e. does fentanyl dosing influence the area of hyperalgesia?] The secondary objectives of this trial are 1) to explore the intraoperative concentrations of fentanyl in these various dosing schemes during and after extracorporeal circulation (ECC). [i.e. determine the time course of fentanyl with ECC and its association with hyperalgesia; explorative] 2) to explore a possible association between fentanyl dosing, hyperalgesia, and persisting pain 3, 6, and 12 months after surgery. [i.e. clinical implication on persistent/chronic pain; explorative]
Being tested
Fentanyl dosing schemes
Medical subject headings
Hyperalgesia, Pain, Postoperative, Chronic Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Fentanyl dosing schemesDrug

    We routinely use fentanyl as the opioid of choice in CABG surgery. However, how much and whether or not to apply it in boli or continuously remain uncertain. We will apply 3 routinely used fentanyl dosing schemes in our hospital. To blind care-givers and patients, in each of the arms a bolus and a continous injection will occur, as delineated in the treatment arms.

Study groups in NCT03450161
Study groupRoleWhat they receive
High-Dose Bolus of FentanylExperimental5 minutes prior to sternotomy, patients will receive a fentanyl bolus of 20 mcg/kg BW (verum) and a perfusion pump with sodium chloride (NaCl 0.9%; placebo) will be begun according to the Shibutani dosing scheme. As in the other arms, patients will be induced with 3mcg/kg BW fentanyl and the treating physician may administer boli on an "as needed" basis.
Receives: Drug: Fentanyl dosing schemes
Low-Dose Bolus of FentanylExperimental5 minutes prior to sternotomy, patients will receive a fentanyl bolus of 3 mcg/kg BW (verum) and a perfusion pump with sodium chloride (NaCl 0.9%; placebo) will be begun according to the Shibutani dosing scheme. As in the other arms, patients will be induced with 3mcg/kg BW fentanyl and the treating physician may administer boli on an "as needed" basis.
Receives: Drug: Fentanyl dosing schemes
Continuous Dose of FentanylExperimental5 minutes prior to sternotomy, patients will receive a NaCl 0.9% bolus (placebo) and a perfusion pump with fentanyl (verum) will be begun according to the Shibutani dosing scheme. As in the other arms, patients will be induced with 3mcg/kg BW fentanyl and the treating physician may administer boli on an "as needed" basis.
Receives: Drug: Fentanyl dosing schemes

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Area of hyperalgesia at 24h

    Determination of secondary, wound hyperalgesia by pin prick (256mN von Frey filament)

    Measured: 24 hours after surgery (+/- 3 hours)

Secondary outcomes (21)
  1. Area of hyperalgesia at 48h

    Determination of secondary, wound hyperalgesia by pin prick (256mN von Frey filament)

    Measured: 48 hours after surgery (+/- 3 hours)

  2. Area of allodynia at 24h

    Determination of allodynia by cotton swab

    Measured: 24 hours after surgery (+/- 3 hours)

  3. Area of allodynia at 48h

    Determination of allodynia by cotton swab

    Measured: 48 hours after surgery (+/- 3 hours)

  4. Persistent Pain at 3 months

    Validated questionnaire to assess pain after by1) mail and 2) phone follow-up

    Measured: 3 months after surgery (+/- 1 week)

  5. Persistent Pain at 6 months

    Validated questionnaire to assess pain after by1) mail and 2) phone follow-up

    Measured: 6 months after surgery (+/- 1 week)

  6. Persistent Pain at 12 months

    Validated questionnaire to assess pain after by1) mail and 2) phone follow-up

    Measured: 12 months after surgery (+/- 1 week)

  7. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run as specified by the time frame of this outcome and the following outcomes.

    Measured: 5 min. (+/- 1 min) prior to sternotomy, a surgical step

  8. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 5 min. (+/- 1 min) after fentanyl/placebo bolus, given just prior to sternotomy

  9. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 30 min. (+/- 1 min) after fentanyl/placebo bolus, given just prior to sternotomy

  10. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: just prior (<1min) to start of pump run, a surgical step

  11. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 5 min. (+/- 1 min) after begin of pump run, a surgical step

  12. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 20 min. (+/- 1 min) after begin of pump run, a surgical step

  13. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 40 min.(+/- 1 min) after begin of pump run, a surgical step

  14. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 60 min.(+/- 1 min) after begin of pump run, a surgical step

  15. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 80 min. (+/- 1 min) after begin of pump run, a surgical step

  16. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 100 min. (+/- 1 min) after begin of pump run, a surgical step

  17. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 120 min.(+/- 1 min) after begin of pump run, a surgical step

  18. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 140 min.(+/- 1 min) after begin of pump run, a surgical step

  19. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 160 min.(+/- 1 min) after begin of pump run, a surgical step

  20. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: 5 min.(+/- 1 min) after end of pump run,a surgical step

  21. Description of perioperative fentanyl concentrations with on-pump extra corporeal circulation

    Fentanyl will be measured from samples taken prior to, during, and after a pump run

    Measured: end of surgery (+/- 5 min)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Mar 2018
  2. Study start14 May 2018
  3. Primary completion1 Feb 2020
  4. Study completion9 Jan 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Single group
Model description
randomized, double-blinded, three arm study
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
80 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03450161
Sponsor's protocol ID
AGO/2017/005
Other IDs
2017-003278-15, 2017
Status last verified
Sep 2024
First submitted
29 Jan 2018
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Fentanyl dosing schemes in people with Hyperalgesia and Opioid Use, run by University Hospital, Ghent at 1 site in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Area of hyperalgesia at 24h (time frame: 24 hours after surgery (+/- 3 hours)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.

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