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Brief Title † | Fentanyl Administered Intraorally for Rapid Treatment of Orthopedic Pain | ||||
Official Title † | Fentanyl Administered Intraorally for Rapid Treatment of Orthopedic Pain in the ED | ||||
Brief Summary | Assess whether transbuccal fentanyl provides more rapid relief of orthopedic pain, than does the comparator Percocet |
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Detailed Description | Patients will be initially deemed eligible for study consideration if, after MGH ED nursing triage, an X-ray is ordered for suspected isolated extremity injury and the triage acuity level is "Minor". Study staff (physicians) will monitor the ED registration and triage areas to assess whether triaged patients are potentially eligible. For ED patients with minor isolated injuries, X-rays are often ordered from triage, where there is a supervising physician (or nurse practitioner) available to examine patients and direct care. Either at triage (for patients undergoing care at that location) or when patients are moved to the ED's Minor Surgery area, the supervising healthcare provider will be approached immediately after that individual's evaluation of the patient, and before any pain medication is administered, to begin the process of eligibility ascertainment. If the provider agrees that the patient may be a candidate for the study, the next step will be for the provider to ask the patient if study staff may approach to discuss the trial. If the patient agrees to have study staff approach to discuss the trial, study personnel (all EM resident or Attending-level physicians) will be introduced by healthcare providers to potential subjects. Study staff will then converse with the patients about the study's aims, methodology, and risks, confirming eligibility and determining if patients will consent to participate. Patients who are approached, but who are determined to be ineligible, will have no data recorded, other than their age and race/ethnicity and the reason they were ineligible. If eligible patients provide written consent in the manner and form dictated by Partners guidelines, the study procedures will commence. For eligible patients who do not give consent, study physicians will emphasize that patient care will be unaffected by their decision. No further contact will occur between study staff and those patients. No identifying information about such patients will be recorded, but their age and race/ethnicity will be recorded. (Recording this information will allow for subsequent assessment for selection bias, and will also help search for patterns in patient types refusing analgesia trial participation.) The actual medication administration will involve the following steps:
Patients will be monitored by a study physician co-investigator physically present with the patient, for a total of 120 minutes after administration of medication. They will be asked q-5-minutes, through 60 minutes, to rate their pain and degree of nausea, as well as to describe any adverse reactions to the medication. Both pain and nausea levels will be recorded using 10-point scales. Use of such scales is common in the pain literature, and is an emerging tool for evaluation of nausea.1,2 Data collection for analgesia efficacy will cease after 60 minutes, but patients will be monitored for at least another 60 minutes to maximize safety; patients will be assessed for discharge suitability by treating clinicians/nurses in the same fashion as other ED patients who receive opioids. Vital signs (respiratory rate, blood pressure, heart rate, pulse oximetry) will be monitored for the two hours of the study. Continuous pulse oximetry will be used during the first study hour, and q5-minute spot-check pulse oximetry will be used during the second study hour; pulse oximetry monitoring will be changed to continuous mode during the second study hour if any spot-check reading falls below 98%. Other (non-pulse oximetry) vital signs will be monitored q5-minutes during the first study hour, and q15-minutes during the second study hour. These vital signs monitoring parameters represent the minimum for study subjects; treating clinicians or study staff physicians can increase the frequency of vital signs monitoring at their discretion. Any study subject not admitted to the hospital, will be discharged under the care of a responsible adult. At the conclusion of the data collection period, patients will be asked if they would want to receive the same medication in the future. Other than a 24-hour telephone call (made only if patients agree), intended to assess for delayed problems such as nausea/vomiting, there will be no other study procedures or interventions.
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Study Phase | Phase I, Phase II | ||||
Study Type † | Interventional | ||||
Study Design † | Treatment, Randomized, Double Blind (Subject, Caregiver, Outcomes Assessor), Placebo Control, Single Group Assignment, Safety/Efficacy Study | ||||
Primary Outcome Measure † | Time to analgesia [ Time Frame: 60 minutes ] [ Designated as safety issue: No ] | ||||
Secondary Outcome Measure † | Occurrence of untoward opioid side effects [ Time Frame: 120 minutes ] [ Designated as safety issue: Yes ] | ||||
Condition † | Pain, Fracture, Sprain | ||||
Intervention † | Drug: Fentanyl rapid dissolving tablet 100mcg Drug: lansoprazole 15mg rapidly dissolving tablet + Percocet PO |
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Recruitment Information Fields | |||||
Recruitment Status † | Not yet recruiting | ||||
Enrollment † | 100 | ||||
Start Date † | July 2008 | ||||
Completion Date | December 2008 | ||||
Eligibility Criteria † | Inclusion/Exclusion Criteria. The study population will comprise patients 18-60 years of age who present to the ED with a chief complaint of extremity injury, and who are triaged to the ED's "Minor Surgery" area. The trigger for evaluation for study eligibility will be the clinician-determined need for extremity radiography to rule-out fracture. To participate in the study, patients must meet the following inclusion and exclusion criteria:
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Gender | Both | ||||
Ages | 18 Years to 60 Years | ||||
Accepts Healthy Volunteers | No | ||||
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Administrative Information Fields | |||||
NCT ID † | NCT00685295 | ||||
Organization ID | FAIRTOP | ||||
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Study Sponsor † | Massachusetts General Hospital | ||||
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Investigators † |
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Information Provided By | Massachusetts General Hospital | ||||
Verification Date | May 2008 | ||||
First Received Date † | May 23, 2008 | ||||
Last Updated Date | May 27, 2008 |