Opioid-free Analgesia for the Management of Acute Post-operative Pain Following Caesarean Section
- Conditions
- Acute Post-operative Pain Following Caesarean Section
- Interventions
- Registration Number
- NCT04539249
- Lead Sponsor
- Olakunle Ifeoluwa Makinde
- Brief Summary
Background: Multimodal analgesia; a combination of opioid and non-opioid analgesics, for management of acute post-operative pain significantly reduces the incidence of adverse effects associated with liberal post-operative opioid use including sedation, respiratory depression, constipation, ileus, urinary retention, delayed recovery, addiction etc. However, opioid addiction remains a worsening public health problem and have followed administration of opioid analgesics for post-operative pain and subsequent chronic use in many addicts; especially the opioid naive. Caesarean section is a commonly performed surgery and is a common source of first exposure to opioids in women. Trend in post-operative analgesia is moving towards opioid-free (multimodal) analgesia; a combination of non-opioid and adjuvant analgesics. Magnesium sulphate is an adjuvant analgesic. When administered peri-operatively, it has been reported to prolong the duration of spinal anaesthesia, decrease post-operative pain and opioid use without adverse effect.
Aim: To determine the effectiveness and safety of a combination of peri-operative intravenous magnesium sulphate, intravenous paracetamol, and post-operative rectal diclofenac as opioid-free, multimodal analgesia for management of acute post-operative pain after a caesarean section.
Null Hypothesis: Combination of intravenous magnesium sulphate, intravenous paracetamol, and rectal diclofenac as analgesia regimen for acute post-operative pain after a caesarean section is not as effective and safe as a routine opioid-based multimodal analgesia regimen used in the study setting.
Alternate Hypothesis: Combination of intravenous magnesium sulphate, intravenous paracetamol, and rectal diclofenac as analgesia regimen for acute post-operative pain after a caesarean section is as effective and safe as a routine opioid-based multimodal analgesia regimen used in the study setting.
Materials and Methods: A randomized clinical trial, comparing a combination of peri-operative intravenous magnesium sulphate, intravenous paracetamol, and post-operative rectal diclofenac with an opioid-based multimodal regimen as control. Eligible patients will be consecutively selected from among women booked for caesarean section at the Federal Medical Centre, Yenagoa. Control group will receive a combination of post-operative intramuscular pentazocine, intravenous paracetamol and rectal diclofenac. Pain intensity will be determined in both groups and compared. Need for rescue opioid analgesic will be determined in both groups and compared. Incidence of any adverse event in both groups will be determined.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 324
- Pregnant women booked for elective, scheduled and urgent caesarean section at the Federal Medical Centre, Yenagoa, Bayelsa State during the study period,
- Pregnant women who give consent to participate in the study.
- Pregnant women with active peptic ulcer disease, active liver disease, hepatic failure, and renal failure,
- Pregnant women with previous history of ischaemic heart disease/myocardial infarction, heart failure, venous thrombosis and stroke,
- Hypersensitivity to pentazocine, paracetamol, diclofenac or magnesium sulphate,
- Pregnant women with history of non-medical use (abuse) of opioids,
- Pregnant women on magnesium sulphate or have a clinical indication to receive magnesium sulphate,
- Pregnant women booked for emergency caesarean section (because the urgency may not allow time for adequate patient counseling before recruitment)
- Pregnant women booked for caesarean section under general anaesthesia or epidural anaesthesia,
- Pregnant women who can neither communicate in english nor colloquial english.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Magnesium sulphate Magnesium sulphate Combination of intravenous magnesium sulphate, intravenous paracetamol and rectal diclofenac Pentazocine Pentazocine Combination of intramuscular pentazocine, intravenous paracetamol and rectal diclofenac
- Primary Outcome Measures
Name Time Method Post-operative Pain Scores Following Caesarean Section at 8 Hours Post-operative 8 hours post-operative Post-operative pain scores following caesarean section at 8 hours post-operative using the Numerical Rating Scale for pain. The Numerical Rating Scale for pain has a minimum score of 0, a maximum score of 10 and a range of 0-10, where higher scores mean a worse outcome (0= No pain at all, 5= Moderate pain and 10= Worst pain imaginable)
Post-operative Pain Scores Following Caesarean Section at 24 Hours Post-operative 24 hours post-operative Post-operative pain scores following caesarean section at 24 hours post-operative using the Numerical Rating Scale for pain. The Numerical Rating Scale for pain has a minimum score of 0, a maximum score of 10 and a range of 0-10, where higher scores mean a worse outcome (0= No pain at all, 5= Moderate pain and 10= Worst pain imaginable)
Post-operative Pentazocine Use 24 hours post-operative Whether or not Pentazocine was used post-operatively
Pentazocine Use as Rescue Analgesia 24 hours post-operative Whether or not pentazocine was used as rescue analgesia
Frequency and Nature of Pentazocine Use 24 hours post-operative Frequency of Pentazocine use per participant in each arm of the study and whether it was used as indicated in the protocol and/or for rescue analgesia
Mean Dose of Pentazocine Used 24 hours post-operative Mean dose of Pentazocine used in each arm of the study
Post-operative Pain Scores Following Caesarean Section at 4 Hours Post-operative 4 hours post-operative Post-operative pain scores following caesarean section at 4 hours post-operative using the Numerical Rating Scale for pain. The Numerical Rating Scale for pain has a minimum score of 0, a maximum score of 10 and a range of 0-10, where higher scores mean a worse outcome (0= No pain at all, 5= Moderate pain and 10= Worst pain imaginable)
- Secondary Outcome Measures
Name Time Method Number of Participants With Post-operative Adverse Events First 24 hours post-operative Number of participants with post-operative adverse events including respiratory depression constipation, ileus, pruritus, urinary retention and any other adverse event recorded during the first 24 hours post-operative.
Number of Participants With Peri-operative Adverse Events Time of first administration of peri-operative analgesia to 2 hours postoperative Number of participants with peri-operative adverse events including hypersensitivity reaction, respiratory depression, bradycardia, hypotension, nausea and vomiting, lightheadedness, presyncope, and any other adverse event recorded from the time of first administration of peri-operative analgesia to 2 hours postoperative
Apgar Scores of the Neonates At first and fifth minutes after birth Apgar scores of the neonates delivered by the women who had caesarean section under the study, taken at first and fifth minutes after birth. Apgar score has a minimum score of 0, a maximum score of 10 and a range of 0-10, where higher scores mean a better outcome (0-3= low Apgar score, 4-6= moderately abnormal Apgar score and 7-10= reassuring Apgar score
Trial Locations
- Locations (1)
Federal Medical Centre, Yenagoa
🇳🇬Yenagoa, Bayelsa State, Nigeria