E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
moderate to severe acute pain in postoperative patients who have undergone elective spine or orthopaedic surgery |
|
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is to assess the need for IV access during postoperative pain treatment with strong opioids using fentanyl ITS. |
|
E.2.2 | Secondary objectives of the trial |
Additional endpoints: · The administration of medication for opioid related side effects or administration of additional analgesic treatment (intravenous/oral) during the use of fentanyl ITS will be evaluated · Patient satisfaction at end: Patient Global Assessment · Pain Scores (NRS): at 6, 12 and 18 hours after application of ITS, and at every change of ITS · Nurse satisfaction at end: Nurse Global Assessment · Physician satisfaction at end: Physician Global Assessment · Device related application site reaction will be recorded (including those of prolonged nature)
|
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients must satisfy the following criteria to be enrolled in the study: 1. Adult, aged 18 or older, male or female. 2. American Society of Anaesthesiology (ASA) pre-operative physical status I, II, or III (Attachment 1). 3. If the patient is female and of childbearing potential, she must have a negative pregnancy test at hospital admission. 4. Patients who will undergo elective spine or orthopaedic surgery. 5. Patients who are expected to have moderate or severe pain requiring parenteral opioids for at least 48 hours after surgery. 6. Patients who are capable of understanding and cooperating with the requirements of the study and operating fentanyl ITS. 7. Patients who have signed and dated the informed consent to participate in the study during the preoperative assessment. 8. Patients who have been admitted to the PACU after general anaesthesia, spinal anaesthetic of < 4 hours duration of action or epidural anaesthesia. Patients with epidural or regional anaesthesia will only be included if the provided analgesia was short lasting and was only given for the period of surgery and not for the period in the recovery room. 9. Patients who are alert and breathing spontaneously for at least 30 minutes in the PACU; respiratory rate 10 to 24 breaths per minute; patients must be able to answer questions and follow commands. 10. Patients with a pain score less than or equal to 4 out of 10 on a Numerical Rating Scale (NRS) at movement of the operated limb or body region, after titration to comfort according to current postoperative procedures. 11. Patients who are expected to remain hospitalised for at least 48 hours postoperatively.
|
|
E.4 | Principal exclusion criteria |
Potential patients who meet any of the following criteria will be excluded from participating in the study: 1. Patients with a history of allergy or hypersensitivity to fentanyl and/or an allergy/hypersensitivity to skin adhesives and/or cetylpyridinium chloride. 2. Patients who are known or suspected to be strong opioid dependent, or who have a too high need for strong opioids. 3. Patients with a history of opioid dependence before the start of the study, defined as meeting any of the criteria for substance dependence specified in Attachment 2. 4. Patients who are known or suspected to have abused any drug substance or alcohol. 5. Patients with chronic pain disorder (DSM-IV 307.80/89 – ICD 10: F45.4). 6. Patients with active systemic skin disease or active local skin disease that precludes fentanyl ITS application. 7.Patients known to have any of the following: · severe chronic obstructive respiratory symptoms; · susceptibility to present respiratory depression (possible synergistic effect associated with CNS drugs); · patients who have a coexisting medical condition, (possibly with chronic pain of another organ) that is likely to interfere with study procedures. Remark: - use of muscle relaxants is allowed (during the course of the general anaesthesia); - use of anti-depressants/anxiolytics is allowed provided that they were taken for the same indication before surgery; - the use of monoamineoxidase-inhibitors (MAO inhibitors) is not allowed during (or 14 days prior to) treatment with fentanyl ITS. 8. Women who are pregnant, breast feeding, or planning to breast feed within 7 days of last dose of study drug. 9. Patients who have taken any investigational drug or used an experimental medical device within 30 days before the start of the study or are currently enrolled in another investigational drug study. 10. Patients who received regular treatment with transdermal strong opioids within 14 days prior to surgery. 11. Patients who have received peri-operative administration of opioids other than morphine, fentanyl, sufentanil, alfentanil or remifentanil. Exception: If there are no medical contraindications, one dose of meperidine, up to 50 mg IV, is allowed within 30 minutes of arrival in the PACU for treatment of shivering. 12. Patients who need postoperatively very high doses of opioids for pain control (more than 40 mg morphine/h equivalent or more than 60 mg pritramid to reach comfort zone (NRS £ 4)) or when more than 6 hours have elapsed since the patient arrived in the PACU. 13. Patients whose postoperative pain is managed with IV PCA or EPI PCA or CEI (continuous epidural infusion). 14. Patients whose postoperative pain would normally be managed with oral or non-opioid analgesia during the first 48 hours. 15. Patients who are being treated in the intensive care unit. 16. Patients who will probably require additional surgical procedures within 72 hours. 17. Patients who are intubated or have a laryngeal mask airway (LMA) at the time of final screening assessments (T0). 18. Patients who are employees of the investigator or the institution who have direct involvement in the study or other trials under the direction of the investigator.
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
Primary endpoint: the use of IV line during treatment with fentanyl ITS will be evaluated. Therefore we will document (at each time point) the amount of patients who have an IV line and compare the actual usage of the IV line with the intended use of the IV line. |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 15 |
E.8.5 | The trial involves multiple Member States | Information not present in EudraCT |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
| |
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |