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Post Operative PainNCT05507554

Different Postoperative Analgesics Use After Ureteroscopy

A study testing Opioid, Non-Opioid Analgesic and Non-Opioid in people with Post Operative Pain and Ureteroscopy, run by Pakistan Kidney and Liver Institute and Research Center at 1 site in Pakistan.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

In this study, we will see the feasibility of a non-opioid pain killers in management of acute post-operative period as well as on discharge from the hospital compared to opioid medications for postoperative pain following URS and stent placement. Read more about this study

Who is it for?
Ages 18 to 60 years
Conditions the study is for
Post Operative Pain, Ureteroscopy, Ureter Stone
What is being tested?
Opioid, Non-Opioid Analgesic and Non-Opioid
Could I receive a placebo?
No, everyone receives an active treatment
How many people
176 participants
Where
1 sitePakistan
Study dates
1 Aug 2022to Dec 2022
Phase
Interventional
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 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Ureteroscopy procedure performed for ureteric stones between age 18 -60 years.
  • Patients with normal Renal and Liver function tests function tests.
  • Patients having no growth on urine culture will be included in this study.
  • Patients with no previous history of ureteroscopy procedure in past.

Who cannot join

  • Patients having history of allergic reaction to any type of the drugs to be used in the study.
  • If Paracetamol contraindicated in severe hepatic impairment, or severe active hepatic disease.
  • If Diclofenac contraindicated in compromised renal function, increased risk of bleeding due to clotting disorder, an increased risk of bleeding, gastric ulcers, alcoholism.
  • If tramadol is contraindicated as in alcoholism, depression and drug abuse.
  • When a patient has a history of opioid abuse.
  • When a patient refuses to participate in the study.
Show all 9Show fewer
  • When patient is unable to give consent.
  • Pregnancy.
  • If the patient has used conventional NSAIDs, Acetaminophen or Tramadol during the 6 hours before surgery,

Trial locations and contacts

1 site in 1 country.

Nadeem Iqbal, FCPS* contact

+92 3345346538

dr_nadeemiqbal84@yahoo.com

Tanweer Bhatty, FRCS contact

+92 3360464991

tanweer.ahmed@pkli.org.pk

Pakistan1 site, 1 recruiting
  • Pakistan Kidney and Liver Institute

    Lahore, Punjab Province, 54000

    Nadeem Iqbal, FCPS*, +92 3345346538, dr_nadeemiqbal84@yahoo.com

    Recruiting

Other trials in Pakistan

About this study

Official title: Effectiveness of Different Postoperative Analgesics Use in the Management of Acute Pain After Ureteroscopy.

In this study, we will see the feasibility of a non-opioid pain killers in management of acute post-operative period as well as on discharge from the hospital compared to opioid medications for postoperative pain following URS and stent placement.

The objective of this study will be to compare the pain control effects of no opioid and opioid pain killers during the post-operative period. This study will be a Randomized Clinical trial. Data will be collected from department of Urology, PKLI, Lahore. All patients included in this study will undergo ureteroscopic laser lithotripsy of ureter stones. One group will receive tramadol (opioid) while other two groups will receive Paracetamol and diclofenac sodium (NSAIDs) respectively. All subjects will receive one of the three pain killers after ureteroscopy procedure for ureter stones in a randomized fashion. Postoperative pain intensity will be measured by the investigator and the nurse in the first hour after the surgery in the recovery room and then in urology ward at 1,6, 12, 24, 48, \& 72 hours using the Numeric Pain Intensity Scale (NPIS).A mean pain score of less than 2 for each category of surgical procedures or analgesics group will be defined as satisfactory pain control. The data will be analyzed using SPSS v 24.

Read the detailed description

Achieving adequate postoperative pain relief should be a definitive goal of patient care in any surgery because pain is one of the most common postoperative symptoms as reported from previous studies. Efforts have begun to implement non opioid protocols for outpatient urologic surgery. Recently it was found that Ureteroscopy (URS) with stent placement is possible without using postoperatve opioids for pain control and stent-related symptoms. To date, attention has focused on the problems of opioid abuse, diversion, and overdose. These issues pertain primarily to those who are already suffering from substance use disorders. More recently, the possibility that legitimate use of prescription opioids has led to incident substance use disorders (iatrogenic addiction) is beginning to gather attention.

When iatrogenic addiction has been considered, it is almost exclusively in the context of chronic pain. Not surprisingly, emergency providers commonly believe that short courses of opioid therapy for acute pain are safe and that their role in the current opioid crisis is limited to attenuating diversion. However, several recent studies have demonstrated that short course opioid therapy for acute pain is associated with future recurrent use of opioids, raising the possibility that short course opioid therapy may be a potential trigger for the onset of opioid related substance use disorders. If so, there are considerable health implications as more than 1 in every 6 patients discharged from an ED are given a prescription for an opioid pain reliever.

In this study, we will see the feasibility of a non-opioid discharge protocol compared to standard opioid medications for postoperative pain following URS and stent placement. We will also evaluate the effect of these analgesic in acute pain management in post op stay in hospital.

Being tested
Opioid, Non-Opioid Analgesic, Non-Opioid
Keywords
Pain, Analgesics, Non-Steroidal, Opioid, Urolithiasis, Ureteroscopy
Medical subject headings
Pain, Postoperative, Ureterolithiasis, Pain, Urolithiasis

What participants receive

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

  • OpioidDrug

    Drug: intravenous injection Tramadol 50 mg and then oral capsule Tramadol 50 mg, once patient starts taking orally.

    Designated coated 14 days supply of pain medication (oral capsule Tramadol 50 mg) will be given to the patients on discharge. For Pain control oral capsule Tramadol 50 mg is administered 2 times per day until the stent will be removed in clinic 2 weeks later.

  • Non-Opioid AnalgesicDrug

    Drug: intravenous injection Paracetamol 1 Gram and then oral Tablet Paracetamol 1 Gram, once patient starts taking orally.

    Designated coated 14 days supply of pain medication (oral Tablet Paracetamol 1 Gram) will be given to the patients on discharge. For Pain control oral Paracetamol 1 Gram is administered 3 times per day until the stent will be removed in clinic 2 weeks later.

  • Non-OpioidDrug

    Drug: intra muscular injection Diclofenac Sodium 50 mg and then oral Tablet Diclofenac Sodium 50 mg, once patient starts taking orally.

    Designated coated 14 days supply of pain medication (oral Tablet Diclofenac Sodium 50 mg) will be given to the patients on discharge. For Pain control oral Diclofenac Sodium 50 mg is administered 2 times per day until the stent will be removed in clinic 2 weeks later.

Study groups in NCT05507554
Study groupRoleWhat they receive
Opioid GroupActive comparatorThis group comprises of patients with ureter stones stones who undergo ureteroscopy procedure. They will be randomized to intravenous injection Tramadol 50 mg. They will also be discharged on Tramadol oral capsule 50 mg for postoperative pain after the ureteroscopy procedure with stent placement
Receives: Drug: Opioid
Paracetamol (Acetaminophen) GroupActive comparatorThis group comprises of patients with ureter stones stones who undergo ureteroscopy procedure. They will be randomized to intravenous injection Paracetamol 1 Gram. They will also be discharged on oral Tablet Paracetamol 1 Gram for postoperative pain after the ureteroscopy procedure with stent placement
Receives: Drug: Non-Opioid Analgesic
Diclofenac Sodium GroupActive comparatorThis group comprises of patients with ureter stones stones who undergo ureteroscopy procedure. They will be randomized to intra muscular injection Diclofenac Sodium 50 mg. They will also be discharged on oral Tablet Diclofenac Sodium 50 mg for postoperative pain after the ureteroscopy procedure with stent placement.
Receives: Drug: Non-Opioid

What is being measured

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

  1. Pain score in post op period at 1 hour.

    Pain score assessment at one hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [1 hour]

  2. Pain score in post op period at 6 hour.

    Pain score assessment at six hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [6 hour]

  3. Pain score in post op period at 12 hour.

    Pain score assessment at twelve hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [12 hour]

  4. Pain score in post op period at 24 hour.

    Pain score assessment at twenty four hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [24 hour]

  5. Pain score in post op period at 48 hour.

    Pain score assessment at forty eight hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [48 hour]

  6. Pain score in post op period at 72 hour.

    Pain score assessment at seventy two hour by utilizing the Numeric Pain Intensity Scale (NPIS), score will be between 0-10.

    Measured: [72 hour]

Secondary outcomes (3)
  1. Patient Satisfaction

    Score on standardized evaluation of patient satisfaction at 7-days post-op. This was on a scale from 1) very dissatisfied to 5) very satisfied. Higher scores are better

    Measured: First 30 post-operative days

  2. 4. Emergency visit for pain symptoms by the patients in the postoperative period after the discharge

    Number of times patients visited health facility for pain exacerbation

    Measured: First 30 post-operative days

  3. Hospital pain killers refill visits of patients for each category of analgesic used

    Number of times patients visited health facility for refill pain killers medication

    Measured: 30 post-operative days

Timeline

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

  1. First posted19 Aug 2022
  2. Study start1 Aug 2022
  3. Primary completionOct 2022 (estimated)
  4. Study completionDec 2022 (estimated)

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
176 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05507554
Sponsor's protocol ID
PKLI Nadeem Iqbal
Status last verified
Aug 2022
First submitted
17 Aug 2022
Last updated
19 Aug 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Kang C, Shu X, Herrell SD, Miller NL, Hsi RS. Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy. J Endourol. 2019 Jun;33(6):480-485. doi: 10.1089/end.2018.0796. Epub 2019 Feb 8.

    PubMed 30618280
  • Salaudeen GO, Afuwape OO, Eyelade OR, Olapade-Olaopa EO. Effectiveness of postoperative analgesia in the management of acute pain in day-case surgeries. Ann Afr Med. 2018 Jul-Sep;17(3):140-144. doi: 10.4103/aam.aam_53_17.

    PubMed 30185683
  • Klueh MP, Hu HM, Howard RA, Vu JV, Harbaugh CM, Lagisetty PA, Brummett CM, Englesbe MJ, Waljee JF, Lee JS. Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naive Patients in the USA: a Retrospective Review. J Gen Intern Med. 2018 Oct;33(10):1685-1691. doi: 10.1007/s11606-018-4463-1. Epub 2018 Jun 11.

    PubMed 29948809
  • Kasman AM, Schmidt B, Spradling K, Chow C, Hunt R, Wu M, Sockol A, Liao J, Leppert JT, Shah J, Conti SL. Postoperative opioid-free ureteroscopy discharge: A quality initiative pilot protocol. Curr Urol. 2021 Sep;15(3):176-180. doi: 10.1097/CU9.0000000000000025. Epub 2021 May 26.

    PubMed 34552459
  • Tam CA, Dauw CA, Ghani KR, Gunaseelan V, Kim T, Leavitt DA, Raisky J, Yan PL, Hollingsworth JM. New Persistent Opioid Use After Outpatient Ureteroscopy for Upper Tract Stone Treatment. Urology. 2019 Dec;134:103-108. doi: 10.1016/j.urology.2019.08.042. Epub 2019 Sep 16.

    PubMed 31536742

Questions about this trial

What is this clinical trial studying?

A study testing Opioid, Non-Opioid Analgesic and Non-Opioid in people with Post Operative Pain and Ureteroscopy, run by Pakistan Kidney and Liver Institute and Research Center at 1 site in Pakistan.

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 4 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: status not confirmed, as of the sponsor's last update on 19 Aug 2022. 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 Pakistan. 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.

Are results available for this study?

Results are not available in the source record.

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

Contact Nadeem Iqbal, FCPS* (+92 3345346538, dr_nadeemiqbal84@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pain score in post op period at 1 hour. (time frame: [1 hour]). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05507554, which also lists 5 linked publications.

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 Aug 2022.

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