PCTKA: Pregabalin, Celecoxib, Total Knee Arthroplasty and Intrathecal Morphine

Sponsor

Chulalongkorn University (Other)

Overall Status

Completed

CT.gov ID

NCT01344213

Collaborator

Bhumibol Adulyadej Hospital (Other), King Chulalongkorn Memorial Hospital (Other)

100

Enrollment

Location

Arms

Duration (Months)

3.7

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

To evaluate whether pregabalin and/or celecoxib could improve analgesic efficacy of intrathecal morphine for patients after total knee arthroplasty.

Condition or Disease	Intervention/Treatment	Phase
Postoperative Pain Management Total Knee Arthroplasty	Drug: Pregabalin Drug: Celecoxib Drug: Pregabalin with celecoxib Drug: Placebo	Phase 4

Detailed Description

A single-dose spinal anesthesia combining with morphine for total knee arthroplasty (TKA) is a simple, economical anesthetic technique commonly used in our hospital. Still some patients could not get effective postoperative pain control. Pregabalin, an anticonvulsant, has been shown to reduce acute pain after molar extraction, laparoscopic cholecystectomy, and reduce postoperative morphine requirement after total hip arthroplasty, and celecoxib, a selective cyclo-oxygenase (COX) - 2 inhibitor, with perioperative prescription is successfully reduces pain score and opioid consumption after TKA under spinal anesthesia alone. However, no clinical study has yet investigated whether preoperative single-dose of pregabalin, celecoxib or in combination compared to placebo can improve analgesic efficacy of intrathecal morphine after TKA. The primary objective of this study was to evaluate whether these medications could reduce pain scores at rest / when movement and morphine requirement after TKA under spinal anesthesia with intrathecal morphine. Secondary outcome assessed include adverse effects, anxiety score and patients' satisfaction score.

Study Design

Study Type:

Interventional

Actual Enrollment :

100 participants

Allocation:

Randomized

Intervention Model:

Factorial Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

Comparison of Analgesic Efficacy Among Pregabalin, Celecoxib, Pregabalin With Celecoxib and Placebo After Total Knee Arthroplasty Under Intrathecal Morphine

Study Start Date :

Jul 1, 2008

Actual Primary Completion Date :

Oct 1, 2009

Actual Study Completion Date :

Oct 1, 2010

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Pregabalin Oral single-dose of pregabalin (150 mg) and 1 capsule of placebo (P) 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg.	Drug: Pregabalin Oral single-dose of pregabalin (150 mg) and placebo (P) 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg. Other Names: Pregabalin: Lyrica
Active Comparator: Celecoxib Oral single-dose of celecoxib (400 mg) and 1 capsule of placebo (C) 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg.	Drug: Celecoxib Oral single-dose of celecoxib (400 mg) and placebo(C)1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg. Other Names: Celecoxib: Celebrex
Active Comparator: Pregabalin with celecoxib Oral single-dose of pregabalin (150 mg) and celecoxib (400 mg) (PC) 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg.	Drug: Pregabalin with celecoxib Oral single-dose of pregabalin (150 mg) and celecoxib (400 mg) (PC) 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg. Other Names: Pregabalin: Lyrica Celecoxib: Celebrex
Placebo Comparator: Placebo Oral single-dose of placebo 2 capsules 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg	Drug: Placebo Oral single dose of placebo 2 capsules 1-2 hours before starting spinal anesthesia with intrathecal morphine 0.2 mg Other Names: Placebo: sugar capsule

Outcome Measures

Primary Outcome Measures

24-hour cumulative morphine consumption [Participants will be followed for the duration of hospital stay, an expected average of 2 weeks]
The time to first morphine requirement will be recorded The cumulative morphine consumption will be recorded at the end of surgery and 2-h, 6-h, 10-h, 24-h, and 48-h postoperatively Visual analog scale (VAS) pain scores at rest will be assessed at the night before surgical date, before starting anesthesia, at the end of surgery, and 2-h, 6-h, 10-h, 24-h and 48-h postoperatively Visual analog scale (VAS) pain scores when on movement will be assessed at the end of surgery, and 2-h, 6-h, 10-h, 24-h and 48-h postoperatively

Secondary Outcome Measures

Anxiety scores (VAS), patients' satisfaction [Participants will be followed for the duration of hospital stay, an expected average of 2 weeks]
Anxiety scores will be assessed at the night before surgical date, before starting anesthesia, at the end of surgery, and 2-h, 6-h, 10-h, 24-h and 48-h postoperatively; 24-h and 48-h patients' satisfaction (0-10,0=dissatisfied and 10= very satisfied)

Eligibility Criteria

Criteria

Ages Eligible for Study:

50 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Patients between 50-75 years of age
Patients with an American Society of Anesthesiologists physical status of I to III
Patients scheduled for primary TKA with a diagnosis of osteoarthritis under spinal anesthesia

Exclusion Criteria:.

Patients had a known allergy to any of the medications being used
a history of drug or alcohol abuse
a history of taking chronic pain medications (ie, show-release preparations of opioids, given that morphine consumption was the primary outcome)
a history of taking pregabalin or gabapentin / non-steroidal anti-inflammatory drugs / COX-2 inhibitors
a psychiatric disorder
a history of impaired renal function (Cr > 1.5 mg/dl), peptic ulcer, asthma, thrombotic cerebrocardiovascular diseases, uncontrolled hypertension
a history of contraindication for spinal anesthesia
a history of bleeding tendency
pregnancy
unable or unwilling to use patient - controlled analgesic (PCA)