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Trial registered on ANZCTR
Registration number
ACTRN12607000208404
Ethics application status
Not yet submitted
Date submitted
10/04/2007
Date registered
16/04/2007
Date last updated
16/04/2007
Type of registration
Prospectively registered
Titles & IDs
Public title
Altered breathing with postoperative pain relief
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Scientific title
A randomised phase 3/4 study to compare the postoperative effects of morphine versus tramadol/ketamine/parecoxib analgesia on respiratory obstructions, apnoeas and oxygen desaturation.
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Obesity
1733
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Respiratory Depression
1734
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Postoperative analgesia
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Condition category
Condition code
Diet and Nutrition
1825
1825
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0
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Obesity
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Respiratory
1826
1826
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0
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Pain management
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A comparison of morphine with a combination of parecoxib, ketamine and tramadol for analgesia in the first 12 hours after surgery. The tramadol to be given by patient-controlled intravenous doses. Continuous recording of respiratory data for 12-18 hours after surgery in all patients.
Doses: tramadol 3mg/kg + 10mg bolus with 10min lockout, ketamine 0.3mg/kg iv + 0.1mg/kg/hr, parecoxib 40mg iv single dose.
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Intervention code [1]
1692
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Prevention
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Comparator / control treatment
Morphine analgesia in the first 12 hours after surgery. The morpine is given by patient-controlled intravenous doses. Continuous recording of respiratory data for 12-18 hours after surgery in all patients.Doses: morphine 1mg bolus with 5min lockout,
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Control group
Active
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Outcomes
Primary outcome [1]
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Reduced number respiratory obstructions or desaturations.
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Assessment method [1]
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Timepoint [1]
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Total for 12 hours to 0600hr on day after surgery.
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Secondary outcome [1]
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Analgesia and side-effects
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Assessment method [1]
4404
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Timepoint [1]
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Average of verbal numeric pain scores for 12hr period to 0600hr, need for rescue analgesia.
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Eligibility
Key inclusion criteria
Obese (BMI>29) patients or airway abnormality on preoperative anaesthesia examination.Likely to require postoperative morphine or equivalent analgesia.Postoperative overnight hospital stay.
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Minimum age
18
Years
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Maximum age
90
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Intrathoracic or upper-abdominal surgery. Previous adverse reaction to any study drugs including nausea or vomiting.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
computer generated table
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Respiratory monitor 12hr recording analysed by researcher blinded to treatment group.
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Phase
Phase 3 / Phase 4
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/06/2007
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
70
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
1976
0
Hospital
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Name [1]
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Department of Anaesthesia and Pain Management, RMH
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Address [1]
1976
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Country [1]
1976
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Australia
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Primary sponsor type
Hospital
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Name
Royal Melbourne Hospital
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Nil
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Address [1]
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Country [1]
1789
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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Melbourne Health Research and Ethics Committee
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Ethics committee address [1]
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
3672
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Approval date [1]
3672
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Ethics approval number [1]
3672
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Summary
Brief summary
Many patients experience some degree of breathing difficulty after major surgery and breathing difficulties may be the basis for serious, but uncommon complications of anaesthesia and surgery. The use of sedatives and morphine-like drugs for the relief of pain, although very necessary, contributes to decreased breathing effort, pauses and obstruction. Patients with obstructive sleep apnoea (OSA) syndrome, associated with a history of snoring, observed pauses in breathing during sleep and daytime sleepiness, may be at especially high risk with anaesthesia. This syndrome is associated with obesity, and may be a partial cause for, many types of heart and lung disease. Specialized high-dependency postoperative care is advocated for these patients. We are interested in patients who do not have a definite diagnosis of OSA or severe symptoms, but who do have a high body mass index (BMI) and some abnormal airway features that imply increased risk of obstruction. Such patients may make up to 20% of patients presenting for elective surgery at the RMH. An initial respiratory monitoring study in progress, suggests that patients with these risk factors have increased breathing difficulties and reduced blood oxygen in the period after surgery. In the proposed study, patients who are considered to be at risk of breathing problems on the basis of questionnaires and examination prior to surgery, will be randomized to either standard opioid (morphine) pain relief for the first day after surgery or to a group where other pain relieving dugs (ketamine, parecoxib and tramadol) are used in an attempt to reduce opioid use while maintaining adequate pain relief. In both groups dugs will be used according to protocols approved by the Acute Pain Service at the Royal Melbourne Hospital.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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A/Prof Duncan Blake
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Address
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Department of Anaesthesia and Pain Management
Royal Melbourne Hospital
Parkville VIC 3050
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Country
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Australia
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Phone
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+61 3 93427925
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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A/Prof Duncan Blake
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Address
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Department of Anaesthesia and Pain Management
Royal Melbourne Hospital
Parkville VIC 3050
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Country
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Australia
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Phone
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+61 3 93427925
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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