Does Pre and Postoperative Dextromethorphan Reduce Post-tonsillectomy Pain in Children?

Phase 4

Completed

• Conditions: Pain, Postoperative
• Interventions: Drug: Placebo; Drug: Dextromethorphan

• Registration Number: NCT02727491
• Lead Sponsor: Dr. Rachel Rooney

Brief Summary

With Institutional ethics board and Health Canada approval, pediatric patients (ages 3-12) undergoing tonsillectomy or adenotonsillectomy (under standardized anesthesia) will be randomized to receive dextromethorphan hydrobromide (1mg/kg orally) 30 min preoperatively and again 8 hours postoperatively OR placebo (syrup identical in taste, appearance and volume) at the same time points. The primary outcome is an integrated assessment of perioperative pain scores and opioid use for 24 hours postoperatively. Secondary outcomes include nausea, vomiting, respiratory depression, and bleeding for 24 hours postoperatively. Our hypothesis is that dextromethorphan will decrease the incidence/severity of post-tonsillectomy pain. The improved pain control will be apparent through reduced opioid consumption and integrated pain scores. This will result in a reduced incidence of opioid-related side effects and adverse events.

Detailed Description

With Institutional ethics board and Health Canada approval and parental consent and child assent, pediatric patients (ages 3-12) undergoing tonsillectomy or adenotonsillectomy (under standardized anesthesia) will be randomized to receive dextromethorphan hydrobromide (1mg/kg orally) 30 min preoperatively and again 8 hours postoperatively OR placebo (syrup identical in taste, appearance and volume) at the same time points. The primary outcome is an integrated assessment of perioperative pain scores and opioid use for 24 hours postoperatively. Pain scores were collected preoperatively at rest and then at 1,2,3,8,9,10 and 24 hours postoperatively using the validated Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Secondary outcomes include nausea, vomiting, respiratory depression, and bleeding recorded by blinded observers for 24 hours postoperatively.

Our hypothesis is that dextromethorphan will decrease the incidence/severity of post-tonsillectomy pain. The improved pain control will be apparent through reduced opioid consumption and integrated pain scores. This will result in a reduced incidence of opioid-related side effects and adverse events.

Study Timeline

• Study Start: 2012-03
• Primary Completion: 2014-09
• Study Completion: 2014-09
• Study First Submitted: 2016-02-11
• Study First Submitted QC: 2016-03-29
• Study First Posted: 2016-04-04
• Status Verified: 2020-09
• Last Update Submitted: 2020-09-17
• Last Update Posted: 2020-09-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 85

Inclusion Criteria

• American Society of Anesthesiologist's (ASA) physical classification I and II
• tonsillectomy or adenotonsillectomy
• admission to extended postoperative care unit

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Exclusion Criteria

• use of monoamine oxidase inhibitors, serotonin reuptake inhibitors or tricyclic antidepressants
• requirement of preoperative sedation
• recent dextromethorphan use (<24 h before surgery)
• intolerance, sensitivity or contraindication to any agents used in the study
• pre-existing chronic pain or chronic analgesic use
• body mass index (BMI) for age percentile greater than 90
• confounding procedural factors which might affect the validity of the data
• inability to adhere to study protocol
• contraindication to volatile anesthetics

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	30 min preoperatively and then again 8 hours postoperatively, received inactive placebo syrup identical in volume, appearance and taste as the experimental group
dextromethorphan	Dextromethorphan	1 mg/kg of dextromethorphan syrup orally 30 min preoperatively and then again 8 hours post-tonsillectomy

Primary Outcome Measures

Name	Time	Method
integrated assessment of pain scores and opioid use	24 hours postoperatively	The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) will be measured at rest 24 hours postoperatively and this will be integrated with total opioid consumption at 24 hours postoperatively. This will be achieved by converting both pain scores and opioid consumption to % change. The % differences for each of the 2 variables are then added together on a per-subject basis to provide a summated % difference. The individual and summated % differences can then be plotted on a single graph and the integrated ranks of the experimental and control groups can be compared with standard statistical tests.(1)

Secondary Outcome Measures

Name	Time	Method
opioid-related adverse effects	up to 24 hours postoperatively	nausea, vomiting, respiratory depression, bleeding
pain scores	1,2,3,8,9 and 10 hours postoperatively	Pain scores at rest on the CHEOPS pain scale