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Randomized Trial of Narcotic vs Non-Narcotic Pain Modulation After Labrum Repair

Primary Purpose

Postoperative Pain, Acute, Opioid Use, Labral Tear, Glenoid

Status
Enrolling by invitation
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Tylenol, Ibuprofen, and Oxycodone
Tylenol and Ibuprofen only
Sponsored by
The Cooper Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Postoperative Pain, Acute focused on measuring Labrum repair, opioid consumption, postoperative pain

Eligibility Criteria

15 Years - 25 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients between the ages of 15 - 25 years old Patients with a diagnosis of a labrum tear who will undergo surgical intervention Exclusion Criteria: Patients under the age of 14 years old Patients age 26 years or older Patients with a nonoperative diagnosis of a labrum tear Patients who elect not to undergo surgical treatment Patients who are on opioid medications preoperatively

Sites / Locations

  • Cooper University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Control - Narcotic Prescription

Experimental - Non-narcotic only

Arm Description

Oxycodone 5 mg 1 tablet every 6 hours PRN Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain

This group will not be sent home with an oxycodone prescription. They will be sent home with the following prescriptions. If this does not manage their pain, they will call the resident on call who will reach out to the PI. The PI will then electronically send in a prescription of oxycodone to their pharmacy if required. The PI or operating surgeon (co-investigators) will be available 24/7 to do this. They will be sent home with these two prescriptions: Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain

Outcomes

Primary Outcome Measures

Postoperative pain control
The subjects will keep track of pain levels through a pain journal which they fill out daily and will bring to the first post-operative appointment. At their first post-operative visit, patients will also bring their pill bottles for a pill count in the office to validate the amount described in the pain journal.

Secondary Outcome Measures

Full Information

First Posted
July 26, 2023
Last Updated
July 26, 2023
Sponsor
The Cooper Health System
Collaborators
New Jersey Health Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT05974423
Brief Title
Randomized Trial of Narcotic vs Non-Narcotic Pain Modulation After Labrum Repair
Official Title
Prospective Randomized Trial of Narcotic vs Non-Narcotic Pain Modulation Following a Labrum Repair
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Enrolling by invitation
Study Start Date
December 16, 2022 (Actual)
Primary Completion Date
December 1, 2024 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The Cooper Health System
Collaborators
New Jersey Health Foundation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine if patients age 15 to 30 years old being treated for shoulder labrum repair and SLAP lesions have significant differences in pain levels postoperatively when treated with a combination therapy of ibuprofen, and acetaminophen compared to oxycodone. Participants will be randomly placed into either the control arm and receive scripts for non-narcotic medications (Tylenol and Ibuprofen) and opioids, or the experimental arm of the study. receiving only a prescription for the non-narcotic medications. Every patient will receive a preoperative Exparel nerve block as is the standard of care for this procedure. Both groups will fill out a pain journal for 14 days following surgery and complete a pill count at the first postoperative visit to validate the amount of pain medication documented in the pain journal.
Detailed Description
The opioid crisis has illuminated the risks of opioid use for pain management, with renewed interest in reducing opioid consumption after common orthopedic procedures. Anti-inflammatory medication is an important component of multimodal pain management for patients undergoing orthopedic surgery. Several relevant studies have inquired about the use of opioid consumption in the management of total knee arthroplasty, total hip arthroplasty, total shoulder arthroplasty as well as arthroscopic shoulder surgeries. There is currently a gap in the literature, however, regarding the use of nerve blocks preoperatively in conjunction with nonopioid pharmacology postoperatively for pain. The goal is to determine if this can reduce pain levels in patients who have undergone surgical management for shoulder labrum or SLAP lesions. Hopefully, the data we can extract will allow future physicians to decrease the number of opioids prescribed and reduce the risks of prolonging the opioid epidemic. The United States is currently in an opioid crisis. This is a public health issue that not only is limited to the United States but is echoed by countries around the world. All physicians must be accountable for the continuation of the crisis but also must be cognizant of ways to end the issue. In 2011, the United States Food and Drug Administration reported that 50 million Americans were prescribed opioids which is close to a 100 percent increase in the amount prescribed in 2008. Similarly, during that same period, opioid overdose became the leading cause of accidental death in young adults; associated with a higher risk of postoperative death, and increased risk of falls and fractures in the elderly. Many ways have been discussed to reduce the prescription of opioids such as standardized opioid prescription protocols, limits on prescription size, and restrictions on opioid use for preoperative and nonsurgical patients. Another theater of opioid use that can be addressed is that of post-operative pain management. The contribution of the potential results of our research could greatly reduce and mitigate the number of opioids prescribed postoperatively if there is no significant difference between the groups. This will be a prospective randomized trial. Patients will be randomly placed into either the control or experimental arm of the study. Every patient will receive Exparel as is the standard of care for this procedure. There will be two groups in this study: Group 1: Oxycodone 5 mg 1 tablet every 6 hours PRN Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain Group 2 (Experimental Group) will not be sent home with an oxycodone prescription. They will be sent home with the following prescriptions. If this does not manage their pain, they will call the resident on call who will reach out to the PI. The PI will then electronically send in a prescription for oxycodone to their pharmacy if required. The PI or operating surgeon (co-investigators) will be available 24/7 to do this. They will be sent home with these two prescriptions: Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain At the time of diagnosis and discussion of surgical intervention, patients will be asked if they would like to participate in this research study. Patients will be considered screen fails should they meet any exclusion criteria. They will be informed that depending on which group they are randomly assigned to, they may have different prescriptions. Should the patient be randomly assigned to the control group, they will be given the above medications. Should the patient be randomly assigned to the experimental group, they will be given the above medication scripts. To note, for shoulder surgeries, Cooper has been using Exparel as a nerve block agent as part of the standard of care. Day 1 after surgery: both groups will begin completing their pain journal for 14 days. We will allow two methods to complete the pain journal: REDCap or paper format. The REDCap version will be emailed to patients daily so they can complete the questions. The paper format will be available to all subjects regardless of if they complete the REDCap surveys. This will be an extra measure to ensure all days are reported and there are no issues with the REDCap. At 2 Weeks post-op: Patients' pain levels with be assessed in the immediate post-operative period at their first follow-up visit with their respective attending physician. The subjects will keep track of pain levels through a pain journal which they fill out daily and will bring to the first post-operative appointment. At their first post-operative visit, patients will also bring their pill bottles for a pill count in the office to validate the amount described in the pain journal. Both groups' subject's involvement will last 2 weeks post-operation. After this 2 week visit, patients will have completed their course of the study. The current standard of practice at Cooper for orthopedic surgeons performing this procedure is oxycodone 5mg PRN, ibuprofen 600mg every 6 hours, and acetaminophen 1000mg every 8 hours.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Postoperative Pain, Acute, Opioid Use, Labral Tear, Glenoid
Keywords
Labrum repair, opioid consumption, postoperative pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Patients will be assigned to one of the following groups: Group 1: Oxycodone 5 mg 1 tablet every 6 hours PRN Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain Group 2 (Experimental Group) will not be sent home with an oxycodone prescription. They will be sent home with the following prescriptions. If this does not manage their pain, they will call the resident on call who will reach out to the PI. The PI will then electronically send in a prescription of oxycodone to their pharmacy if required. The PI or operating surgeon (co-investigators) will be available 24/7 to do this. They will be sent home with these two prescriptions: Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control - Narcotic Prescription
Arm Type
Active Comparator
Arm Description
Oxycodone 5 mg 1 tablet every 6 hours PRN Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain
Arm Title
Experimental - Non-narcotic only
Arm Type
Experimental
Arm Description
This group will not be sent home with an oxycodone prescription. They will be sent home with the following prescriptions. If this does not manage their pain, they will call the resident on call who will reach out to the PI. The PI will then electronically send in a prescription of oxycodone to their pharmacy if required. The PI or operating surgeon (co-investigators) will be available 24/7 to do this. They will be sent home with these two prescriptions: Tylenol 1000 mg every 8 hours Ibuprofen 600 mg every 6 hours as needed for pain
Intervention Type
Drug
Intervention Name(s)
Tylenol, Ibuprofen, and Oxycodone
Other Intervention Name(s)
Both Narcotic and Non-narcotic
Intervention Description
A script for these three medications will be provided
Intervention Type
Drug
Intervention Name(s)
Tylenol and Ibuprofen only
Other Intervention Name(s)
Non-narcotic only
Intervention Description
A script for only these two medications will be provided initially following surgery. Should the patient need stronger medication for adequate pain control, the on-call physician will provide a script for oxycodone
Primary Outcome Measure Information:
Title
Postoperative pain control
Description
The subjects will keep track of pain levels through a pain journal which they fill out daily and will bring to the first post-operative appointment. At their first post-operative visit, patients will also bring their pill bottles for a pill count in the office to validate the amount described in the pain journal.
Time Frame
2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
15 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients between the ages of 15 - 25 years old Patients with a diagnosis of a labrum tear who will undergo surgical intervention Exclusion Criteria: Patients under the age of 14 years old Patients age 26 years or older Patients with a nonoperative diagnosis of a labrum tear Patients who elect not to undergo surgical treatment Patients who are on opioid medications preoperatively
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Catherine J Fedorka, MD
Organizational Affiliation
Cooper Hospital Orthopedic Surgery
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cooper University Hospital
City
Camden
State/Province
New Jersey
ZIP/Postal Code
08103
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
30800477
Citation
Familiari F, Huri G, Simonetta R, McFarland EG. SLAP lesions: current controversies. EFORT Open Rev. 2019 Jan 28;4(1):25-32. doi: 10.1302/2058-5241.4.180033. eCollection 2019 Jan.
Results Reference
background
PubMed Identifier
30197715
Citation
Hester WA, O'Brien MJ, Heard WMR, Savoie FH. Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. Open Orthop J. 2018 Jul 31;12:331-341. doi: 10.2174/1874325001812010331. eCollection 2018.
Results Reference
background
PubMed Identifier
36535593
Citation
Jain A, Aniq H, Mistry A. SLAP Injury and the Superior Labrum. Semin Musculoskelet Radiol. 2022 Oct;26(5):577-584. doi: 10.1055/s-0042-1758840. Epub 2022 Dec 19.
Results Reference
background
PubMed Identifier
25532917
Citation
Matsuki K, Sugaya H. Complications after arthroscopic labral repair for shoulder instability. Curr Rev Musculoskelet Med. 2015 Mar;8(1):53-58. doi: 10.1007/s12178-014-9248-5.
Results Reference
background
PubMed Identifier
34196965
Citation
Pascarella G, Costa F, Del Buono R, Pulitano R, Strumia A, Piliego C, De Quattro E, Cataldo R, Agro FE, Carassiti M; collaborators. Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia. 2021 Nov;76(11):1492-1498. doi: 10.1111/anae.15536. Epub 2021 Jul 1.
Results Reference
background
PubMed Identifier
36049874
Citation
O'Neill A, Lirk P. Multimodal Analgesia. Anesthesiol Clin. 2022 Sep;40(3):455-468. doi: 10.1016/j.anclin.2022.04.002. Epub 2022 Aug 2.
Results Reference
background
PubMed Identifier
28719941
Citation
Elmallah RK, Chughtai M, Khlopas A, Newman JM, Stearns KL, Roche M, Kelly MA, Harwin SF, Mont MA. Pain Control in Total Knee Arthroplasty. J Knee Surg. 2018 Jul;31(6):504-513. doi: 10.1055/s-0037-1604152. Epub 2017 Jul 18.
Results Reference
background
PubMed Identifier
31491863
Citation
Dada O, Gonzalez Zacarias A, Ongaigui C, Echeverria-Villalobos M, Kushelev M, Bergese SD, Moran K. Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review. Int J Environ Res Public Health. 2019 Sep 5;16(18):3257. doi: 10.3390/ijerph16183257.
Results Reference
background
PubMed Identifier
27558150
Citation
Hamilton TW, Athanassoglou V, Trivella M, Strickland LH, Mellon S, Murray D, Pandit HG. Liposomal bupivacaine peripheral nerve block for the management of postoperative pain. Cochrane Database Syst Rev. 2016 Aug 25;2016(8):CD011476. doi: 10.1002/14651858.CD011476.pub2.
Results Reference
background
PubMed Identifier
32002676
Citation
Kaye AD, Novitch MB, Carlson SF, Fuller MC, White SW, Haroldson AR, Kaiser JA, Elkersh MA, Brunk AJ, Jeha GM, Cornett EM. The Role of Exparel Plus Meloxicam for Postoperative Pain Management. Curr Pain Headache Rep. 2020 Jan 30;24(3):6. doi: 10.1007/s11916-020-0837-2.
Results Reference
background
PubMed Identifier
34228280
Citation
Blair HA. Bupivacaine/Meloxicam Prolonged Release: A Review in Postoperative Pain. Drugs. 2021 Jul;81(10):1203-1211. doi: 10.1007/s40265-021-01551-9. Epub 2021 Jul 6.
Results Reference
background

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Randomized Trial of Narcotic vs Non-Narcotic Pain Modulation After Labrum Repair

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