Comparison of Patient Controlled Analgesia (PCA) Versus Bolus Narcotic Therapy for the Treatment of Vaso-Occlusive Crisis (VOC)
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Purpose
This research is being done to find out the best way to give narcotics for pain relief in adults with sickle cell disease and painful crisis. This study is a comparison of two ways of giving narcotics. The first way is what occurs now in the Emergency Acute Care Unit (EACU) where patients are given a single intravenous (iv) dose of a narcotic which is repeated by the nurse as needed to control the pain. The second way is to provide a single iv dose of narcotic and then allow the patient to push a button and receive one or more additional doses of narcotic when he/she thinks it is needed. Our hypothesis is that PCA will be a more effective way of controlling pain.
| Condition | Intervention | Phase |
|---|---|---|
|
Sickle Cell Disease Vaso-occlusive Crisis |
Procedure: Patient controlled analgesia Drug: NAIBOD |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | PCA for Pain Control in Adults With Sickle Cell Disease in the ED Decreases Admission Rates Over Standard Bolus Therapy |
- Decrease in admissions for those treated with a PCA in the ED v those that are given bolus narcotic dosing [ Time Frame: Measured at time of discharge from ED ] [ Designated as safety issue: No ]
- Length of stay [ Time Frame: Endpoints will be the time at which the decision for discharge from the EACU or transfer from the EACU to inpatient admission to the hospital is made ] [ Designated as safety issue: No ]
- Total narcotic used [ Time Frame: Endpoints will be the time at which the decision for discharge from the EACU or transfer from the EACU to inpatient admission to the hospital is made ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 120 |
| Study Start Date: | September 2007 |
| Estimated Primary Completion Date: | September 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: 1
In this arm patients will be randomized to receive a bolus of narcotic followed by PCA.
|
Procedure: Patient controlled analgesia
Patients in this arm will be treated with a bolus of narcotic followed by PCA
|
|
Active Comparator: 2
In this arm patients will be randomized to the current standard of care of bolus narcotic treatment.
|
Drug: NAIBOD
In this arm patients will receive the current standard of care of IV bolus narcotic therapy
|
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Documented sickle cell disease
- Signed consent in outpatient clinic or during a prior hospitalization
- 18+ years of age
- Seen in the ED with sickle cell pain crisis - this will be based on patients chief complaint that they are in a VOC.
- Requires IV administration of narcotics ( has failed oral narcotic therapy at home
- Must be 2 weeks since their last randomization on this study.
Exclusion Criteria:
- Contraindication to the use of IV narcotics
- Hypotension with SBP ≤ 90
- Respiratory rate ≤9
- Altered mental status
- Patient unable to understand how to use the PCA device
- Patient unwilling to use PCA device
- Pulse oximeter reading of ≤ 94% on room air
- Patient is allergic to IV morphine & hydromorphone & fentanyl.
- Patient is allergic to oral hydromorphone & morphine & oxycodone
- Patient has been randomized on this study 3 times before
Contacts and Locations| United States, Maryland | |
| Johns Hopkins Hospital | |
| Baltimore, Maryland, United States, 21205 | |
| Principal Investigator: | Sophie Lanzkron, MD | Johns Hopkins University |
More Information
No publications provided
| Responsible Party: | Sophie Lanzkron, MD, Johns Hopkins University |
| ClinicalTrials.gov Identifier: | NCT00711698 History of Changes |
| Other Study ID Numbers: | NA_00001163 |
| Study First Received: | July 7, 2008 |
| Last Updated: | August 4, 2009 |
| Health Authority: | United States: Institutional Review Board |
Additional relevant MeSH terms:
|
Anemia, Sickle Cell Anemia, Hemolytic, Congenital Anemia, Hemolytic Anemia Hematologic Diseases Hemoglobinopathies Genetic Diseases, Inborn Narcotics |
Central Nervous System Depressants Physiological Effects of Drugs Pharmacologic Actions Analgesics Sensory System Agents Peripheral Nervous System Agents Central Nervous System Agents Therapeutic Uses |
ClinicalTrials.gov processed this record on May 23, 2013