Study of the Safety, Tolerability and Analgesic Efficacy of Multiple Doses of Ketorolac Tromethamine (IN) for Postoperative Pain

Study Overview
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Brief Summary
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This was a randomized, double blind, placebo-controlled study in subjects who have undergone major surgery. Each subject's study participation consisted of a screening visit, a 2-day treatment period, and a follow-up visit. Following surgery, subjects were randomly assigned to receive intranasally (IN) ketorolac 10 mg, IN ketorolac 30 mg, or placebo when the pain intensity (PI) rating equaled at least 40 on a 100-mm visual analog scale (VAS). Thereafter, subjects received study drug every 8 hours, with the last dose given at 40 hours. For pain not relieved by the study drug, the subjects had access to morphine sulfate (MS) administered via patient controlled analgesia (PCA). The primary objective was to evaluate the analgesic efficacy of multiple intranasal (IN) doses of ketorolac over 2 days. The secondary objective was to evaluate the safety and tolerability of this dosing regimen.

Official Title
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A Phase 2, Double-blind, Randomized Study of the Safety, Tolerability and Analgesic Efficacy of Multiple Doses of Ketorolac Tromethamine Administered Intranasally for Postoperative Pain

Conditions
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Postoperative Pain

Intervention / Treatment
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* Drug: Ketorolac tromethamine
* Drug: Ketorolac tromethamine
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men or women, age 18 years or older Body weight > or = 100 pounds (45.4 kg) and < or = 300 pounds (136.1 kg) Women of childbearing potential must have had a negative serum pregnancy test result prior to entry into the study Able to provide written informed consent At least moderate pain as determined by a PI score of > or = 40 mm on a 100-mm VAS Expected to remain in the hospital for at least 48 hours Willing and able to comply with all testing and requirements defined in the protocol Willing and able to complete the posttreatment visit Exclusion Criteria: Allergy or sensitivity to ketorolac or ethylene diamine tetraacetic acid (EDTA) Allergic reaction to aspirin or other nonsteroidal anti-inflammatory drug (NSAIDs) Current upper respiratory tract infection or other respiratory tract condition that could interfere with the absorption of the nasal spray or with the assessment of adverse events Use of any IN product within 24 hours prior to study entry Clinically significant abnormality on screening laboratory tests History of cocaine use resulting in nasal mucosal damage Active peptic ulcer disease, recent (defined as within 6 months) gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding Advanced renal impairment or a risk for renal failure due to volume depletion A history of any other clinically significant medical problem, which in the opinion of the investigator would interfere with study participation Participation within 30 days of study entry or within 5 times the half-life, whichever is longer, in another investigational drug study Allergy or significant reaction to opioids Pregnancy or breastfeeding Previous participation in this study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ketorolac tromethamine (5%)<br> | Drug: Ketorolac tromethamine<br>* 10 mg Intranasal (2 x 100 uL of a 5% solution)<br>|
| Experimental: Ketorolac tromethamine (15%)<br> | Drug: Ketorolac tromethamine<br>* 30 mg Intranasal (2 x 100 uL of a 15% solution)<br>|
| Placebo Comparator: Placebo<br> | Drug: Placebo<br>* Intranasal<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Morphine Sulfate (MS) Use in Milligrams by Patient-controlled Analgesia (PCA) Through 24 Hours |  | 8-hour intervals from the start of dosing through 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total MS Use in Milligrams by PCA From the Start of Dosing Through 48 Hours |  | 8-hour intervals from the start of dosing through 48 hours | 
| Total MS Use in Milligrams by PCA From 24 Hours After the Start of Dosing Through 48 Hours |  | 8-hour intervals from 24 hours after the start of dosing through 48 hours | 
| Pain Intensity Difference (PID) Scores | Ratings of Pain Intensity (PI) were made using a 100-mm Visual Analog Scale (VAS) on which 0 = no pain and 100 = worst pain possible. PID was calculated by subtracting the posttreatment score from the baseline score, where the baseline score was the PI rating made prior to the first dose of study medication. | 6 hours after study drug administration |