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Ibuprofen Plus Acetaminophen Versus Oxycodone Alone After Hand Surgery

NCT03111186 — Phase 2, Completed, 40 participants, University of Southern California

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A Randomized Trial Comparing Ibuprofen Plus Acetaminophen Versus Oxycodone Alone After Outpatient Soft Tissue Hand Surgery

RegistryNCT03111186
StatusCompleted
PhasePhase 2
Study typeInterventional; randomized, parallel, masking: none, supportive care
Enrollment40 (Actual)
SponsorUniversity of Southern California (Other)
ConditionsCarpal Tunnel Syndrome, Dupuytren Contracture, Trigger Digit, Ganglion Cysts, De Quervain Disease
InterventionsOxycodone Hcl 5Mg, Ibuprofen 400 mg, Acetaminophen 650 mg (Drug)
Datesstart 2017-04-24, primary completion 2019-05-01, completion 2019-05-01, first posted 2017-04-12, last updated 2019-09-26
Locations1 site in United States

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-Summary

This study is about pain control and medication following outpatient soft-tissue hand surgery. We hope to learn if ibuprofen and acetaminophen will achieve similar pain relief and satisfaction when compared with oxycodone alone.

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+Detailed description

Opiate analgesics remain the most popular option following outpatient hand surgery despite growing evidence that non-opiate analgesics may provide equivalent pain relief with fewer adverse effects and greater overall satisfaction. The purpose of this randomized trial is to compare the efficacy, side effect profiles and satisfaction associated with Ibuprofen plus Acetaminophen versus Oxycodone alone following outpatient hand surgery. No previous studies have compared the use of opiate analgesics with acetaminophen/ibuprofen following outpatient hand surgery. Patients will be randomized to receive either oxycodone alone or acetaminophen and ibuprofen following outpatient soft tissue hand surgery. Patients will be randomized to receive one of the two aforementioned pain regimens. Patients will be given a booklet in which to record pain level by visual analog scale (VAS), satisfaction with pain control, brief pain inventory and any side effects. Patients will be seen in clinic 1 week after surgery to review symptoms. Patients may also be contacted by phone to review daily log of symptoms. Patients will be seen in clinic 1 week after surgery per standard of care.

+Arms and interventions

ArmTypeInterventionsDescription
Opiate groupActive comparatorDrug: Oxycodone Hcl 5MgGroup receiving oxycodone alone (oxycodone HCl 5 mg up to six times daily as needed for pain)
Non-opiate groupActive comparatorDrug: Ibuprofen 400 mg; Drug: Acetaminophen 650 mgGroup receiving ibuprofen and acetaminophen (acetaminophen 650 mg up to four times daily and ibuprofen 400 mg up to six times daily as need for pain)
  • Oxycodone Hcl 5Mg (Drug), also known as oxycodone: oxycodone HCl 5 mg up to six times daily as needed for pain
  • Ibuprofen 400 mg (Drug): Ibuprofen 400 mg up to six times daily as needed for pain
  • Acetaminophen 650 mg (Drug): Acetaminophen 650 mg up to four times daily as needed for pain

+Outcome measures

Primary outcomes

  • change in VAS pain scale [baseline, daily - up to 1 week postoperative]: Visual Analog Score - pain scale, patient questionnaire

Secondary outcomes

  • change in Brief Pain Index [baseline, daily - up to 1 week postoperative]: Brief Pain Index - pain scale, patient questionnaire
  • change in pain diary [baseline, daily - up to 1 week postoperative]: Pain Diary - pain scale, patient questionnaire

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* age greater than 18 years
* scheduled to undergo elective outpatient soft tissue hand surgery for one of the following procedures: Carpal tunnel release, Dupuytren contracture release, trigger digit release, ganglion cyst removal, de Quervain's release.
* primary language is English or Spanish

Exclusion Criteria:

* any pre-existing condition requiring preoperative opiate analgesia, eg chronic pain syndrome
* allergy to acetaminophen, ibuprofen, or oxycodone
* renal impairment or liver disease either documented based on history or when preoperative creatinine, BUN, or liver function tests are outside the normal range provided by the lab
* peptic ulcer disease or any history of gastrointestinal bleeding
* coagulopathy documented on history, review of systems, or based on preoperative lab testing where PT, PTT, or INR are outside the normal range provided by the lab
* pregnancy based on positive beta-HCG test which is performed on the day of the surgical procedure as is standard protocol

+Locations (1)

FacilityCityCountryStatus
Keck School of Medicine of the University of Southern CaliforniaLos Angeles, CaliforniaUnited States

+Publications

  • Coluzzi F, Bragazzi L, Di Bussolo E, Pizza G, Mattia C. Determinants of patient satisfaction in postoperative pain management following hand ambulatory day-surgery. Minerva Med. 2011 Jun;102(3):177-86. PMID 21593720
  • Munns JJ, Awan HM. Trends in carpal tunnel surgery: an online survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2015 Apr;40(4):767-71.e2. doi: 10.1016/j.jhsa.2014.12.046. Epub 2015 Mar 4. PMID 25747738
  • Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008 Mar;11(2 Suppl):S63-88. PMID 18443641
  • Rodgers J, Cunningham K, Fitzgerald K, Finnerty E. Opioid consumption following outpatient upper extremity surgery. J Hand Surg Am. 2012 Apr;37(4):645-50. doi: 10.1016/j.jhsa.2012.01.035. Epub 2012 Mar 10. PMID 22410178
  • Nauta M, Landsmeer ML, Koren G. Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials. Am J Surg. 2009 Aug;198(2):256-61. doi: 10.1016/j.amjsurg.2008.11.044. PMID 19628064
  • Rawal N, Allvin R, Amilon A, Ohlsson T, Hallen J. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol. Anesth Analg. 2001 Feb;92(2):347-51. doi: 10.1097/00000539-200102000-00013. PMID 11159230
  • Mitchell A, van Zanten SV, Inglis K, Porter G. A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery. J Am Coll Surg. 2008 Mar;206(3):472-9. doi: 10.1016/j.jamcollsurg.2007.09.006. Epub 2007 Nov 26. PMID 18308218
  • Joris J. Efficacy of nonsteroidal antiinflammatory drugs in postoperative pain. Acta Anaesthesiol Belg. 1996;47(3):115-23. PMID 8959196
  • Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010 Apr 1;110(4):1170-9. doi: 10.1213/ANE.0b013e3181cf9281. Epub 2010 Feb 8. PMID 20142348
  • Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001 Dec;38(6):633-8. doi: 10.1067/mem.2001.118863. PMID 11719741
  • McCartney CJ, Brull R, Chan VW, Katz J, Abbas S, Graham B, Nova H, Rawson R, Anastakis DJ, von Schroeder H. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology. 2004 Aug;101(2):461-7. doi: 10.1097/00000542-200408000-00028. PMID 15277930
  • Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am. 2010 Jun;35(6):956-60. doi: 10.1016/j.jhsa.2010.02.001. Epub 2010 Apr 9. PMID 20381981

+Investigators

My Notes