Clinical trial NCT03987022
Conditions: Opioid Substitution Treatment
Keywords: Anti-inflammatory agents non-steroidal
Sponsor: MetroHealth Medical Center
Start date: 2019-08-01; Completion date: 2022-04-25
Enrollment: 66 participants; Allocation: RANDOMIZED; Intervention model: PARALLEL

Brief summary:
The purpose of this randomized controlled trial is to determine whether, "ICE-T," a multimodal postoperative pain regimen composed of around the clock ice packs, toradol, and tylenol, has improved pain control compared to the standard narcotic based postoperative pain regimen in patients undergoing total laparoscopic gyn surgery.

Detailed description:
Laparoscopy is a frequently used route for hysterectomy. Yet few studies have investigated opioid-sparing postoperative regimens for this common surgery. The study objective was to determine whether ice packs, Tylenol, and Toradol (ICE-T), an opioid-sparing multimodal postoperative pain regimen, has improved pain control compared with a standard opioid-centric postoperative pain regimen in total laparoscopic hysterectomy patients.

The study was a randomized controlled trial. It included total laparoscopic hysterectomy postoperative patients that were randomized to the ICE-T or standard regimen. The ICE-T regimen prescribed scheduled around-the-clock ice-packs, acetaminophen and ketorolac. The standard protocol prescribed as needed ibuprofen and acetaminophen/oxycodone based on pain score. Both regimens included intravenous hydromorphone for breakthrough pain. However, subjects in the ICE-T group who requested additional narcotic medications prior to postoperative day 4, were prescribed supplemental narcotics in addition to the ICE-T regimen. The subjects pain control and quality of recovery were assessed on postoperative day 1 and 4.

Arms: arm 1: Regimen #1 "ICE-T" Opioid Sparing Regimen At the end of surgery patients will receive 30mg of intravenous (IV) toradol. Once out of the post anesthesia care unit (PACU) patients will receive

1. ICE PACKS applied to the surgical sites every hour for 20 minutes Around the clock (ATC) until discharge.
2. 6 hours from the time of first dose of surgery patients will receive 30mg of IV toradol ATC until discharge.
3. Once out of the PACU will receive 1 gram of Tylenol per os (PO) every 6 hours for a total of 4 grams daily ATC until discharge
4. Patients will receive dilaudid 0.2mg IV every 3 hours as needed (PRN) for breakthrough pain.
5. Patients will be discharged home with (PO) Tylenol and PO toradol as needed (PRN).
6. If patients requested additional opioids prior to POD4 they were given a supplemental narcotic prescription to ensure adequate pain control arm 2: Regimen #2 STANDARD Postoperative Regimen

1. Once out of the PACU patients will receive "Standard" postoperative regimen
2. Motrin 600mg PO every 4 hours PRN pain scale 1-3 pain
3. Percocet 1 tab PO every 4-6 hours PRN pain scale 4-6 pain
4. Percocet 2 tabs PO every 7-10 hours PRN pain scale 7-10 pain
5. Patients will receive dilaudid 0.2mg IV every 3 hours PRN for breakthrough pain.
6. Patients will be discharged home with Motrin and Percocet for pain PRN.
Interventions: intervention 1: Ketorolac intervention 2: Opioids intervention 3: Ice Packs intervention 4: Tylenol intervention 5: Motrin intervention 6: Dilaudid Injectable Product intervention 7: Percocet 5Mg-325Mg Tablet
Intervention descriptions: intervention 1: Use of non-steroidal anti-inflammatory drug for pain control postoperatively intervention 2: Use of narcotic for pain control postoperatively intervention 3: Placement of Ice packs on surgical sites postoperatively intervention 4: Use of pain medication postoperatively intervention 5: Use of non-steroidal anti-inflammatory drug for pain control postoperatively intervention 6: Use of narcotic for pain control postoperatively intervention 7: Use of combination tablet of Tylenol and Oxycodone for pain control postoperatively

Protocol documents:
ICF_001.pdf: 
HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
"ICE-T" Postoperative Multimodal Pain Regimen Compared to the Standard Regimen in
Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial
Introduction
You are being asked to participate in this research study "ICE-T" Postoperative Multimodal
Pain Regimen Compared to the Standard Regimen in Laparoscopic Gynecologic Surgery: a
Randomized Controlled Trial. Before you can decide whether or not to volunteer for this study,
you must be informed of the purpose of the research study, how this study may help you, any
risks to you, and what is expected of you. This process is called informed consent.
You do not have to participate in this study. You may stop your participation in this study at any
time without changing your current or future relations with MetroHealth Medical Center or its
doctors.
If you decide to participate in this study you will be told about any new information learned
during the course of the study that might cause you to change your mind about staying in the
study. If you withdraw we will still provide you with information regarding possible impacts to
your health status or future health care decisions.
Why is this study being done?
The purpose of this study is to determine if use of ice packs and Tylenol/Toradol (ICE T
regimen) is as effective for pain as narcotic/opioid use after laparoscopic gynecological
surgery.
66 total patients will participate in the study.
What is involved in the study?
Frequency of Visits
This study will not require any additional visits other than those already scheduled. You will
receive one regimen or another for pain after surgery. After surgery, we will follow you with
pain scale scores at 4 hours and 24 hours after surgery and will obtain information about your
post surgery recovery. Once discharged, we will call you regarding your well being as far as 96
hours after surgery.
Screening – You are being asked to participate in this study because you meet the screening
criteria as set forth by the investigators.
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
Page 1 of 7
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HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Randomization/study intervention
Using chance, a method of selection called randomization (similar to a coin toss) will be used. In
this study, you will be assigned to one of two treatment groups. The ICE-T group or the
Standard group.
Regimen #1 Intervention Group
At the end of surgery patients will receive 30mg of intravenous toradol. Once out of the post
anesthesia care unit patients will receive:
1. ICE PACKS applied to the surgical sites every hour for 20 minutes around the clock until
discharge.
2. Every 6 hours from the time of first dose patients will receive 30 milligrams of intravenous
toradol around the clock until discharge.
3. Once out of the recovery unit, patients will receive 1 gram of oral Tylenol every 6 hours for a
total of 4 grams daily around the clock until discharge
4. Patients will receive dilaudid 0.2 milligrams intravenously every 3 hours as needed for
breakthrough pain.
5. Patients will be discharged home with oral Tylenol and toradol as needed.
Regimen #2 STANDARD after surgery regimen (Control group)
1. Once out of the recovery room patients will receive “Standard” after surgery regimen
2. Motrin 600 milligrams orally every 6 hours as needed for pain scores of 1-3 on pain scale
3. Percocet 1 tablet every 4-6 hours orally as needed for pain score of 4-6 on pain scale  4.
Percocet 2 tabs by mouth every 7-10 hours orally as needed for pain score 7-10 on pain
scale
5. Patients will receive dilaudid 0.2 milligrams intravenous every 3 hours as needed for
breakthrough pain.
6. Patients will be discharged home with oral Motrin and Percocet for pain as needed.
Duration
The entire duration of the study is 4 days in total.
What happens if I discontinue or withdraw from the study?
If you withdraw from the study before its completion, you may be asked to return or dispose of all
study medication and, for your safety, to come in for a final study visit in order to ensure you have
adequate pain control and continue to meet postoperative milestones.
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
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HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Investigator-Initiated Termination of Participation: There may be instances that would require
investigators to terminate the participation of particular subjects (e.g., subject non-compliance
with research, subject not benefiting from research). We may also stop the study if we notice
there is an increase in pain in 10% of patients or more with the ICE-T regimen.
What are the risks of this study?
Your participation in this study may involve the following risks associated with the medications
that compose the novel multimodal pain regimen, ICE-T:
Tylenol Risks:
Rare cause of liver toxicity (1% or less)
Rare cause of serious kidney disease (1% or less)
Rare risk of allergic reaction (1% or less)
Rare risk of overdose (1% or less)
ICE
Uncommon risk of hypothermia (>1% to 10%)
Uncommon risk of shivering (>1% to 10%)
Rare risk of wound infections/complications (<1%)
TORADOL
Rare risk of gastrointestinal complications, i.e. bleeding (<1%).
Rare risk of cardiovascular disease (<1%) and contraindicated in setting of coronary artery
bypass graft (CABG).
Rare risk of renal disease (<1%) and contraindicated in patients with renal failure
Rare risk of bleeding (<1%) and contraindicated in patients with suspected or confirmed
bleeding.
Rare risk of allergic reaction (<1%) and contraindicated in patients with previous reaction to
Non-steroidal anti-inflammatory drugs (NSAID)
The ICE-T combination is experimental.
There is a potential risk that the ICE-T after surgery regimen may not control pain as well as
the standard regimen.
This study may involve risks that are currently unforeseeable.
Emotional and Psychological Risks –
Some of the questions we ask may be upsetting, or you may feel uncomfortable answering
them. If you do not wish to answer a question, you may skip it and go to the next question.
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
Page 3 of 7
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HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Your condition may not improve or may worsen while you are taking part in this study.
We cannot predict all risks or potential side effects. There may be unknown and/or delayed
risks that may occur months or years after treatment.
Are there benefits to taking part in the study?
Participation in this research study might be a direct benefit to you. No guarantee of benefit or
any other result can be made. The potential benefits to you from participating in this study may
include decreased opioid requirement after surgery, improved pain control, decreased nausea
and vomiting, and earlier bowel movement. Your participation in this study may aid in our
understanding of pain management after laparoscopic gynecologic surgery and may benefit
patients undergoing laparoscopic gynecologic surgery in the future.
What other options are there?
This is a research study. You may decide not to participate.
If you do not wish to participate in this study, you will receive the standard before surgery and
after surgery medications for your surgery.
What are the costs?
All testing and services of the study will be provided at no cost. You (or your insurance) are
responsible for all other costs that are part of your usual medical care and that would have
been done regardless of your enrollment in the study. If your health insurance or Medicare
requires any co-payment, co- insurance or deductible associated with your usual medical care,
you will be responsible for making the payment.
What happens if I am injured while participating in this study?
All research involves a chance that something bad might happen to you. This may include the
risk of personal injury. In spite of all safety measures, you might develop a reaction or injury
from being in this study. If such problems occur during the course of the study, you must
contact your study doctor, Dr. Robert Pollard at the (216) 778-4444. Necessary medical care
will be provided to you by The MetroHealth System. The MetroHealth System has not set
aside funds to pay you for any such reactions or injuries or for the related medical care. This
medical care is not free. You and/or your insurance company will be responsible for the costs.
However, you can still try to collect compensation for injury related to malpractice, fault, or
blame on the part of those involved in the research, including the hospital.
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
Page 4 of 7
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HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Will I be paid for participating in this study?
You will not be paid or compensated for your participation in this study.
HIPAA:
As part of this study, we are collecting Protected Health Information (PHI) such as: your
telephone number, name or initials medical record or prescription numbers and dates related to
the individual (e.g. birthday). This information is being collected for the purpose of contacting you
and ensuring your safety. All information will be kept on a secure database and in a locked
office. Only the study team will have access to these files. The investigators will have access
to your PHI collected until data analysis is complete. At that time, the PHI will be destroyed.
The study file will be kept for 4 years after study completion, at which time it too will be destroyed.
You have the right to withdraw your permission/authorization for us to access your PHI at any
time except to the extent the PHI already collected by the investigators before your withdrawal
has already been acted upon based on your signed Authorization. No new PHI about you will be
collected for study purposes unless required by law.
What about Confidentiality?
We will make every effort to keep your research records private, but confidentiality cannot be
assured. The MetroHealth System has no control over the use of this information once it is
released.
Records that identify you and this consent form may be looked at by a regulatory agency such
as:
The Food and Drug Administration (FDA)
Department of Health and Human Services agencies
MetroHealth Institutional Review Board
National Committee for Quality Assurance
If the results of the study are published or presented in public, your name will not be used.
Centralized Data Collection or Registries
The results of your tests will be stored in a centralized computer or data registry at the OBGYN
office at MetroHealth Medical Center, Cleveland, Ohio for 4 years.
What are my rights as a study participant?
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
Page 5 of 7
18-June-2019
HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Taking part in this study is voluntary. You have the right to choose not to take part in this
study. If you do not take part in the study, your doctor will still take care of you. You will not
lose any benefits or medical care to which you are entitled. If you withdraw from the study,
with your written permission, clinical data will continue to be collected from your medical
records.
If you chose to take part, you have the right to stop at any time. You will be told of any new
findings from this or other studies that may affect your health, welfare, or willingness to stay in
this study. By signing this consent form, you do not waive any of your legal rights.
If you are an employee or student, whether or not you take part in this study will not affect your
job, current or future medical care, or studies.
A description of this clinical trial will be available on http://www.ClinicalTrials.gov, as required
by U.S. Law. This Web site will not include information that can identify you. At most, the
Website will include a summary of the results. You can search this Web site at any time.
Does MetroHealth or any member of the research team have a financial conflict of
interest in this study?
None.
Whom do I call if I have questions or problems?
If you have questions about any part of the study now or in the future, or if you wish to
communicate concerns or a complaint you should contact Dr. Robert Pollard who may be
reached at (216) 778-4444. If you experience any side effects or injuries while participating in
this study, please contact Dr. Robert Pollard who may be reached at (216) 778-4444. For after
hours, weekends and/or holidays, please page Dr. Darvish at (216) 207-4933. If you have any
questions about your rights as a research participant, or if you wish to express any concerns or
complaints please contact the MetroHealth Medical Center’s Institutional Review Board (which is
a group of people who review the research to protect your rights at (216) 778-2021.
Instructions on how to “Page”:
Dial: (216) 207-4933 After the beep, enter your phone number followed by the # sign
Hang up
Someone will call you back
[ICE-T for post GYN surgery Pain]
Consent & HIPAA Form
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HUMAN INVESTIGATION CONSENT FORM


HUMAN INVESTIGATION CONSENT FORM
CR #: CR00010575
Date
METROHEALTH MEDICAL CENTER IRB #: IRB18-00920
Human Investigation Consent & HIPAA AuthorizationApproved: 6/18/2019
Expiration Date: 5/16/2022 11:59 PM
Patient/Subject Acknowledgement:
The procedures, purposes, known discomforts and risks, possible benefits to me and to others,
and the availability of alternative procedures regarding this research study have been
explained to me. I have read this consent form or it has been read to me, and I have been
given the opportunity to ask questions or request clarifications for anything I do not
understand. I voluntarily agree to participate in this study. I have been given a copy of this
consent form.
___________________________________
Patient/Subject Signature
Date
___________________________________
Signature of Person Obtaining Informed Consent
Date
_______
Time
_______
Time
[ICE-T for post GYN surgery Pain]
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HUMAN INVESTIGATION CONSENT FORM

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