| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Ankle fracture (anaesthesia for surgery) |
|
| E.1.1.1 | Medical condition in easily understood language |
| Ankle fracture (anaesthesia for surgery) |
|
| E.1.1.2 | Therapeutic area | Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Anesthesia and Analgesia [E03] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 18.0 |
| E.1.2 | Level | LLT |
| E.1.2 | Classification code | 10054865 |
| E.1.2 | Term | Malleolar fracture |
| E.1.2 | System Organ Class | 100000004863 |
|
| 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 |
| To study difference in combined short term postoperative pain and opioid use following peripheral nerve block (PNB) anaesthesia versus spinal anaesthesia (SA) for ankle fracture surgery. |
|
| E.2.2 | Secondary objectives of the trial |
To compare the following parameters in the two trial groups: - Difference in rebound pain following cessation of PNB versus SA. - Postoperative opioid related adverse effects. - Patient experienced satisfaction and quality of recovery. - Adverse events. - Pain and opioid need day 2-7 postoperatively.
|
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
- Patients > 18 years old scheduled for internal fixation of an ankle fracture (malleolar fracture). - Ability to read and understand Danish and give informed oral and written consent.
|
|
| E.4 | Principal exclusion criteria |
- Allergy towards any drug in trial protocol - Bodyweight < 52 kg - Contraindications for SA according to national guidelines - Current gastro-intestinal bleeding - Proximal fibular fracture or multitrauma/other fractures - Cognitive or psychiatric dysfunction or alcohol/narcotic substance abuse causing expected inability to comply with study protocol as evaluated by anaesthesiologist/investigator - No available anaesthesiologist with PNB capability at scheduled time of operation - Neuropathy / neurological dysfunction in the lower extremities - Habitual daily use of opioids - Pregnancy (known or suspected) or breastfeeding - Infection at anaesthesia injection site - Nephropathy requiring dialysis - Acute porphyria |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| • Difference between the anaesthesia groups in Integrated Pain Score (IPS) for the period 0-27 hours post-anaesthesia. IPS is based on Numeric Rating Scale pain score Area Under the Curve (NRS-AUC) and total morphine consumption. |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| 27 hours post-anaesthesia. |
|
| E.5.2 | Secondary end point(s) |
Difference between anaesthesia groups regarding: 1) Rebound pain: NRS-AUC pain for a 6-hour period from patient-reported time of cessation of sensory block (PNB or spinal). 2) NRS-AUC pain 0-27 hours post-anaesthesia. 3) Morphine use 0-27 hours (PCA pump) 4) Opioid adverse effects 0-27 hours = Clinically Meaningful Events (CME) assessed by the OR-SDS score 5) Quality of Recovery (QoR-15 score) 0-27 hours 6) “Risk patients” i.e. number of patients with IPS +100 to +200 (= high pain and high morphine consumption) 7) Peak NRS pain score 0-27 hours 8) “High pain patients” i.e. number of patients reaching peak NRS ≥ 7 9) NRS pain scores postoperative (PO) days 2-7 10) Need for on demand opioids PO day 2-7 11) Opioid adverse effects PO day 2 = CMEs assessed by the composite OR-SDS score 12) Overall patient satisfaction with anaesthesia, NRS-score 13) Postoperative nerve symptoms on PO day 7 14) Number of adverse events / adverse reactions registered |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-8) 27 hours post-anaesthesia 9, 10, 12, 13) Postoperative day 7 11) Postoperative day 2 14) 20 hours post-anaesthesia |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | Yes |
| E.6.3 | Therapy | No |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | No |
| 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 | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | No |
| E.8.1.6 | Cross over | No |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Yes |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 2 |
| 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 | 2 |
| E.8.5 | The trial involves multiple Member States | No |
| 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 | No |
| 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
|
| LVLS (telephone interview on postoperative day 7) |
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 1 |
| E.8.9.1 | In the Member State concerned months | 6 |
| E.8.9.1 | In the Member State concerned days | |