Comparison of Meperidine and Fentanyl on Pain Scale and QOL in Brachytherapy

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ClinicalTrials.gov Identifier: NCT02684942

Recruitment Status : Completed

First Posted : February 18, 2016

Results First Posted : June 1, 2017

Last Update Posted : June 1, 2017

Sponsor:

Information provided by (Responsible Party):

Saengrawee Thanthong, Chulabhorn Cancer Center

Study Description

Brief Summary:

Purpose: To compare the pain level and quality of life of the two sedation regimens consisting of diazepam in combination with meperidine or fentanyl.

Materials and methods: A total of 40 patients (160 sessions of brachytherapy), unselected brachytherapy out patients at Chulabhorn Hospital, Thailand were enrolled with informed consent and randomized to receive meperidine or fentanyl. Data of perceived pain (according to standard 10-cm visual analog scales [VAS]), and perceived Quality of life (EQ-5D) were collected. Patients and all brachytherapy staffs directly involved with the procedure were blinded about the drug used.

Condition or disease	Intervention/treatment	Phase
Pain Quality of Life	Drug: Meperidine Drug: Fentanyl	Phase 4

Detailed Description:

Methods Patients Unselected, forty female adults, aged 20 years old or older, diagnosed with cervical cancer and treated with brachytherapy as outpatients at Chulabhorn Hospital, Thailand between June 2011 and September 2012 were enrolled in the study with their informed consents. The study was approved by The Chulabhorn Research Institutional Review Board and Chulabhorn Ethics committee. All the patients were treated with four sessions of ICRT(Intracavitary Radiation Therapy). Inclusion criteria were: Age 20 - 80 years, can understand and provide information, no trouble hearing and good conscious, agree to participated and had performance levels at ECOG 0-2. The patients were randomized to receive either meperidine (1 mg/kg) or fentanyl (1 ug/kg) with diazepam 10 mg both. Nursing staffs who prepared the drugs picked the drugs from lotteries organized into 6 lots on it.

Procedures Perceived pain score according to standard 10-cm visual analog scales (VAS) was assessed prior to treatment and every 15 minutes from the start to the end of the ICRT procedure. Perceived Quality of life (EQ-5D) was assessed before the treatment and immediately after the completion of each brachytherapy treatment session. Information regarding which drug was used was concealed to all the patients and brachytherapy staffs directly involved with the procedures. The procedures involved a radiation oncologist, two nurses, a practical nurse, a radiotherapist, and a medical physicist.

Firstly, before the procedure the patients must NPO(Nothing per oral) for 6 hours and was inserted with intravenous catheter for IV sedation drug depending on the randomized drug that they received.

Secondly, the patients laid down on brachytherapy stretcher and were treated according to the standard ICRT protocol. Each randomized patient had 4 fractions of ICRT, so a single patient will receive Fentanyl and Diazepam 2 fractions and Meperidine and Diazepam 2 fractions. The drugs used were diluted with normal saline to 10 ml. and labeled as "Protocol drug". The actual content within the syringes was known only to a nurse that did not directly involve in the study. Syringes prepared for the meperidine group contained 50 mg of meperidine, while syringes prepared for the fentanyl group contained 100 mg of fentanyl. Both drugs were drawn into 10-cc syringes and appeared colorless.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	40 participants
Allocation:	Randomized
Intervention Model:	Crossover Assignment
Masking:	Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	Comparison of Meperidine and Fentanyl on Pain Scale and Quality of Life in Cervical Cancer Patients Receiving Brachytherapy: A Double-blind, Randomized Controlled Trial
Study Start Date :	October 2012
Actual Primary Completion Date :	March 2013
Actual Study Completion Date :	March 2014

Resource links provided by the National Library of Medicine

Drug Information available for: Meperidine hydrochloride Meperidine Fentanyl Fentanyl citrate

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Meperidine,Fentanyl,Meperidine,Fentanyl Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and third fraction of brachytherapy. And injection fentanyl 1 ug./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at second and fourth fraction of brachytherapy.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil
Active Comparator: Fentanyl,Meperidine,Fentanyl,Meperidine Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at second and fourth fraction of brachytherapy. And injection fentanyl 1 umg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and third fraction of brachytherapy.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil
Active Comparator: Meperidine,Meperidine,Fentanyl,Fentanyl Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and second fraction of brachytherapy. And injection fentanyl 1 ug./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at third and fourth fraction of brachytherapy.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil
Active Comparator: Fentanyl,Fentanyl,Meperidine,Meperidine Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at third and fourth fraction of brachytherapy. And injection fentanyl 1 ug./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and second fraction.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil
Active Comparator: Meperidine,Fentanyl,Fentanyl,Meperidine Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and fourth fraction of brachytherapy. And injection fentanyl 1 ug./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score more than 4 at second and third fraction of brachytherapy.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil
Active Comparator: Fentanyl,Meperidine,Meperidine,Fentanyl Injection meperidine 1 mg./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at second and third fractionof brachytherapy. And injection fentanyl 1 ug./kg. to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4 at first and fourth fraction of brachytherapy.	Drug: Meperidine Injection meperidine 1 mg/kg with diazepam 0.1 mg/kg.to intravenous 5 minutes before inserting the applicator and then when the patients had pain score greater or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Pethidine Drug: Fentanyl Injection meperidine 1 mg/kg to intravenous 5 minute before insertion the applicator and then when the patients had pain score greater than or equal to 4. All patients received supplement oxygen cannula 3 LPM continuously monitored for saturation, pulse and monitored every 5 minutes for blood pressure. Other Name: Fentanil

Outcome Measures

Primary Outcome Measures :

Pain Score [ Time Frame: From date of the first fraction until date of the last fraction of brachytherapy, once a week for four weeks ]
Perceived pain score according to standard 10-cm visual analog scales (VAS) was assessed before injection of medicine for every 15 minutes up to 120 minutes.The minimum and maximum scores were 0, 10. Score 0 means no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain and 10 worst pain.

Secondary Outcome Measures :

Quality of Life [ Time Frame: From date of the first fraction of brachytherapy until date of the last fraction of brachytherapy,once a week for 4 weeks ]
Perceived Quality of life (EQ-5D) was assessed before the first brachytherpy and immediately after completion of each of the 4 brachytherapy fractions. The EQ-5D have 5 dimensions: mobility, self-care, usual activities, topics each content 3 responses: no problems, some problems, extreme problems.

Other Outcome Measures:

Ovoids Size [ Time Frame: after complete applicator insertion. ]
Size of ovoids that a pair part of brachytherapy applicator insert in vagina trough cervix.
Tumor Size [ Time Frame: Before insert applicator in each fraction of brachytherapy. ]
Size of tumor at cervix measured by the doctor before insert applicator.
Meperidine Dose [ Time Frame: after complete treatment. ]
Sum of meperidine dose when finish each fraction of brachytherapy
Fentanyl Dose [ Time Frame: after complete treatment. ]
Sum of fentanyl dose when finish each fraction of brachytherapy

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:	20 Years to 80 Years (Adult, Older Adult)
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Aged 20 years old or older,
Diagnosed with cervical cancer
On course of external Radiation therapy
Treated with brachytherapy 4 times.

Exclusion Criteria:

Pregnant
Previously underwent intracavitary brachytherapy
Illiterate

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02684942

Sponsors and Collaborators

Chulabhorn Cancer Center

Investigators

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Principal Investigator:	Saengrawee Thanthong, RN.	54 moo 4 Kampangpet 6 Taladbangken Laksi Bangkok, THAILAND 10210

More Information

Publications of Results:

Agostoni M, Fanti L, Arcidiacono PG, Gemma M, Strini G, Torri G, Testoni PA. Midazolam and pethidine versus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultrasound endoscopy: a prospective randomized controlled trial. Dig Liver Dis. 2007 Nov;39(11):1024-9. Epub 2007 Oct 29.

Other Publications:

Davidson SE, Symonds RP, Lamont D, Watson ER. Does adenocarcinoma of uterine cervix have a worse prognosis than squamous carcinoma when treated by radiotherapy? Gynecol Oncol. 1989 Apr;33(1):23-6.

Arunachalam D, Thirumoorthy A, Devi S, Thennarasu. Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments. Indian J Palliat Care. 2011 Sep;17(3):184-90. doi: 10.4103/0973-1075.92334.

Dzeletovic I, Harrison ME, Crowell MD, Ramirez FC, Yows CR, Harris LA, Pasha SF, Gurudu SR, Leighton JA, Heigh RI. Impact of fentanyl in lieu of meperidine on endoscopy unit efficiency: a prospective comparative study in patients undergoing EGD. Gastrointest Endosc. 2013 Jun;77(6):883-7. doi: 10.1016/j.gie.2013.01.013. Epub 2013 Mar 6.

Patel NC, Heckman MG, Palmer WC, Cangemi D, DeVault KR. A comparison of patient satisfaction with sedation between fentanyl/midazolam and meperidine/midazolam in patients undergoing endoscopy. Am J Gastroenterol. 2014 May;109(5):772-4. doi: 10.1038/ajg.2014.31.

Kwekkeboom KL, Dendaas NR, Straub M, Bradley KA. Patterns of pain and distress during high-dose-rate intracavity brachytherapy for cervical cancer. J Support Oncol. 2009 May-Jun;7(3):108-14.

Movafegh A, Ghafouri A, Nasr-Esfahani M, Gholamrezanezhad A, Madhkhan S. Post-thoracotomy analgesia--comparison epidural fentanyl to intravenous pethidine. Middle East J Anaesthesiol. 2007 Feb;19(1):111-22.

Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. Aliment Pharmacol Ther. 2009 Apr 15;29(8):817-23. doi: 10.1111/j.1365-2036.2009.03943.x. Epub 2009 Jan 20.

Smith MD, Todd JG, Symonds RP. Analgesia for pelvic brachytherapy. Br J Anaesth. 2002 Feb;88(2):270-6. Review.

Soysal S, Karcioglu O, Demircan A, Topacoglu H, Serinken M, Ozucelik N, Tirpan K, Gunerli A. Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: a double-blind, randomized controlled trial. Adv Ther. 2004 Sep-Oct;21(5):312-21.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Thanthong S, Rojthamarat S, Worasawate W, Vichitvejpaisal P, Nantajit D, Ieumwananontachai N. Comparison of efficacy of meperidine and fentanyl in terms of pain management and quality of life in patients with cervical cancer receiving intracavitary brachytherapy: a double-blind, randomized controlled trial. Support Care Cancer. 2017 Aug;25(8):2531-2537. doi: 10.1007/s00520-017-3662-3. Epub 2017 Mar 18.

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Responsible Party:	Saengrawee Thanthong, Mrs, OCN, Chulabhorn Cancer Center
ClinicalTrials.gov Identifier:	NCT02684942
Other Study ID Numbers:	20/2553
First Posted:	February 18, 2016 Key Record Dates
Results First Posted:	June 1, 2017
Last Update Posted:	June 1, 2017
Last Verified:	May 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Yes

Keywords provided by Saengrawee Thanthong, Chulabhorn Cancer Center:


Meperidine Fentanyl Pain management brachytherapy

Additional relevant MeSH terms:

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Fentanyl Meperidine Analgesics, Opioid Narcotics Central Nervous System Depressants Physiological Effects of Drugs Analgesics	Sensory System Agents Peripheral Nervous System Agents Adjuvants, Anesthesia Anesthetics, Intravenous Anesthetics, General Anesthetics

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