Minimizing Narcotic Analgesics After Endocrine Surgery

Study Overview
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Brief Summary
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This research is being done to better understand and test if the investigators can minimize narcotic medication for controlling pain after thyroid or parathyroid surgery. This research will be performed at Doctors Hospital At Renaissance in the investigators clinic and the perioperative area. Participants will be randomly chosen to receive one of two options for pain management that the investigators are already using in the care of patients after surgery. One option includes a narcotic medication and one option includes a non-narcotic and a narcotic as needed. Participants will be asked to complete a form about the level of pain and how much pain medication was needed after surgery in the hospital and while at home. Participants will not have to do any additional visits to participate in this study. The investigators will obtain the research materials at the same time as the usual care visits around the participants' surgery.

Detailed Description
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A study team member will give the participant a copy of the informed consent form to read. Participants will have a chance to ask questions about the study before agreeing to participate. If participants agree, they will be randomly chosen to receive one of two options for pain management that the investigators are already using in the care of patients (option 1: Tylenol (also known as acetaminophen) with tramadol if needed, or option 2: Tylenol #3 as needed) after surgery. Participants will be asked to complete a form about the level of pain and how much pain medication was needed after surgery in the hospital and while at home. Participants will come to the GME General Surgery Center approximately one week after surgery for a post-operative visit so that the investigators can see how much pain medication was used and how much pain the participant had in the first few days after surgery. Participants will not have to do any additional visits to participate in this study. The investigators will obtain the research materials at the same time as the usual care visits around the participants' surgery. It should take approximately 2 minutes each day to complete.

Official Title
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Minimizing Narcotic Analgesics After Thyroid or Parathyroid Surgery

Conditions
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Thyroid Diseases, Parathyroid Diseases, Parathyroid Adenoma, Parathyroid Hyperplasia, Thyroid Cancer, Thyroid Nodule, Thyroid Neoplasms, Thyroid Goitre

Intervention / Treatment
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* Drug: Acetaminophen 500Mg Cap
* Drug: Tylenol #3 Oral Tablet
* Drug: Tramadol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients 18 years of age or older, Who are undergoing thyroid or parathyroid surgery at DHR by an Endocrine Surgery faculty member, Provide informed consent to participate in the study in English or Spanish, Patients will be included if they are discharged the same day or on postoperative day 1, Patients who undergo central lymphadenectomy will be included, Patients who undergo two operations within a 2-week period (for example a thyroid lobectomy followed by subsequent completion thyroidectomy) will only have the postoperative narcotic requirements following the initial operation included for the study analysis. Patients who have a complication, such as seroma or hematoma, requiring return to the operating room within 48 hours will be included in the study for the initial operation only. Exclusion Criteria: Patients who undergo lateral neck lymph node dissection will be excluded from the study due to the extent of the operation requiring a different analgesic regimen; Patients allergic to any of the study drugs will be ineligible; Patients who undergo two operations within a 2-week period (for example a thyroid lobectomy followed by subsequent completion thyroidectomy) will only have the initial operation included for the study analysis. Patients with a formal diagnosis of hepatic failure will be ineligible Patients with any diagnosis of chronic pain requiring treatment with ongoing narcotic regimen will be ineligible

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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: option 1: Tylenol (also known as acetaminophen) with tramadol if needed, or option 2: Tylenol #3 as needed
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Acetaminophen<br>Tylenol (also known as acetaminophen) 1000mg every 6 hours for 3 days and tramadol 50 mg every 6 hours as needed for moderate to severe pain | Drug: Acetaminophen 500Mg Cap<br>* non-narcotic medication first with narcotic as second choice<br>* Other names: Tylenol;Drug: Tramadol<br>* non-narcotic medication first with narcotic as second choice<br>|
| Active Comparator: Codeine Acetaminophen<br>Tylenol #3 (codeine-acetaminophen) 1 tab every 4 hours or 2 tabs every 6 hours as needed for pain | Drug: Tylenol #3 Oral Tablet<br>* Narcotic medication first<br>* Other names: codeine-acetaminophen;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Staged narcotic analgesic regimen is non-inferior to narcotics in controlling pain | Patient pain scores will be logged using Wong-Baker FACES pain rating scale (range 0-10) and scores will be assessed for differences between the study arms | Patient will report pain score up to two weeks after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Is there a difference in the duration of postoperative pain requiring medication | The number of days after surgery that participants required pain medications will be counted and assessed for difference between the study arms | Patient will report medication requirements up to two weeks after surgery | 
| Is there a difference in the medication requirement | The type and quantity of pain medications used after surgery will be counted and assessed for difference between the study arms | Patient will report medication requirements up to two weeks after surgery | 
| Staged regimen cross over to narcotic | The type and quantity of pain medications used after surgery will be counted and number of patients requiring cross over will be assessed | Patient will report medication requirements up to two weeks after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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opioid addiction, pain management, analgesia, endocrine surgery