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Trial registered on ANZCTR
Registration number
ACTRN12608000028303
Ethics application status
Approved
Date submitted
15/01/2008
Date registered
18/01/2008
Date last updated
17/11/2009
Type of registration
Prospectively registered
Titles & IDs
Public title
Intravenous paracetamol in patients undergoing major abdominal surgery
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Scientific title
The pharmacokinetic, metabolic and safety profile of intravenous paracetamol in adult patients undergoing major abdominal surgery
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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:
Major abdominal surgery
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sepsis
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pharamacokinetics and metabolism
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Condition category
Condition code
Anaesthesiology
2836
2836
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0
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Pain management
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Surgery
2837
2837
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0
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Other surgery
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intravenous paracetamol, 1g, is given 6 hourly for 3 days in adult patients undergoing major abdominal surgery
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Intervention code [1]
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Treatment: Surgery
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Intervention code [2]
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Treatment: Drugs
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Comparator / control treatment
None
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Urine levels of paracetamol metbolites at 2, 4, 6 hours
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Assessment method [1]
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Timepoint [1]
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After 1st dose and after 1st dose on 3rd day
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Primary outcome [2]
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Blood levels of paracetamol at 0, 10, 20, 40, 60, 90, 120, 240 and 360 minutes
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Assessment method [2]
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Timepoint [2]
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After the 1st dose and on 3rd day (after 1st dose)
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Secondary outcome [1]
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blood cytokine levels, IL-6, TNF-a, IL-8, IL-1b, IL-10 and IL-12(p70) will be assayed using multiplex biometric enzyme-linked immunosorbant assay (ELISA)-based immunoassay
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Assessment method [1]
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Timepoint [1]
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once daily on postoperative days 1-3
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Secondary outcome [2]
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pain scores
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Assessment method [2]
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Timepoint [2]
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once daily on postoperative days 1-3
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Secondary outcome [3]
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'sickness score' scale based on vital signs and biochemical parameters
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Assessment method [3]
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Timepoint [3]
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once daily on postoperative days 1-3
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Eligibility
Key inclusion criteria
Adults undergoing major abdominal surgery
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Minimum age
20
Years
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Maximum age
85
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
Exclusion criteria: history of past or present ethanol or substance misuse; nutritional deficiency; hepatic disease, including history of hepatitis B or C; previous adverse reaction to paracetamol; comedication with enzyme inducing or inhibiting drugs, including barbiturates, phenytoin and rifampicin.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
Illness severity score will be used to record the severity of illness/ sepsis if any in the post-operative period
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Phase
Not Applicable
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Type of endpoint/s
Pharmacokinetics / pharmacodynamics
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/02/2008
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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
20
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Otago
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Country [2]
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New Zealand
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State/province [2]
735
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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HealthCare Otago Charitable Trust
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Address [1]
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C/O Dunedin Hospital
Gt King Street
Dunedin
Dunedin
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
Dunedin School of Medicine, University of Otago
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Address
Gt King Street
Dunedin
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Country
New Zealand
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Dunedin hospital
Gt King Street
Dunedin
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Address [1]
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Dept Anaesthesia & Intensive Care
Dunedin hospital
Gt King St
Dunedin
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Country [1]
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New Zealand
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Lower South Regional Ethics Committee
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Ethics committee address [1]
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229 Moray Place Dunedin
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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01/11/2007
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Approval date [1]
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07/01/2008
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Ethics approval number [1]
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LRS/07/11/039
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Summary
Brief summary
Recently, in New Zealand, intravenous paracetamol has become available, and is used for postoperative pain control after major operations. However there are a number of concerns regarding the safety of paracetamol: firstly paracetamol is toxic in overdose because of a toxic metabolite, produced by a minor metabolic pathway; secondly this toxic metabolite is detoxified using glutathione, a substance that may be deficient in fasted patients; and thirdly the major metabolic pathways of paracetamol may be inhibited by cytokines (released by tissue inflammation) resulting in an increase in the toxic metabolite produced by the minor pathway. This raises the possibility of an increased risk of hepatotoxicity in this vulnerable group of patients. Interleukin 1b is known to inhibit the expression of a number of Phase I, Phase II and transporter genes, some of which are involved in paracetamol metabolism. In cultured hepatocytes, expression of UGT1A1 and UGT2B3 mRNA is reduced by IL-6, even in the presence of an inducer (dexamethasone). Exposure to IL-6, and to a lesser extent IL-1b, was associated with decreased expression of sulfotransferases in cultured hepatocytes. In animal models interferon-? has been shown to down regulate P-glycoprotein. In critically ill children with sepsis, CYP activity is reduced in association with increased levels of interleukin 6. Phenytoin metabolism (CYP2C9) is decreased in association with elevated IL-6. In patients with heart failure, reduced activity of CYP1A2 was associated with increased IL-6, and reduced CYP2C19 was associated with increased TNF-a, but CYP2D6 and CYP2E1 were not affected by either cytokine. However, in human hepatocyte cultures, CYP2E1 mRNA had decreased expression under the influence of interferon-?, but had increased expression with IL-4. The down-regulation of hepatic metabolism may be influenced by enzyme induction and species, in addition to being cytokine specific.
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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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Mathew Zacharias
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Address
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Dept Anaesthesia & Intensive Care
Dunedin Hospital
Dunedin
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Country
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New Zealand
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Phone
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+64 3 4740999
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Fax
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+64 3 4747650
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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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Mathew Zacharias
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Address
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Dept Anaesthesia & Intensive Care
Dunedin Hospital
Dunedin
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Country
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New Zealand
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Phone
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+64 3 4740999
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Fax
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+64 3 4747650
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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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