Clinical Trial: NSAIDS Versus Opioids in Acute SER II Ankle Fractures

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Pain Management With NSAIDS in Acute Ankle Fractures Type Supination, External Rotation (SER) II: A Prospective Randomized, Single Blinded Controlled Study

Brief Summary: This study is being conducted to evaluate whether NSAIDS are more or less effective in bone healing than opioids in acute fracture pain. Participants will be randomized to one of three groups for first line treatment of pain related to the fracture.

Detailed Summary:

Pain management in acute fractures is challenging and influenced by several factors contributing to pain perception. These factors include but are not limited to tissue damage by the local impact, mechanical stress at the fracture ends, and central perception of the noxious stimulus. Tissue damage and mechanical stress leads to inflammation and further to local swelling. Swelling itself is significant contributor in pain development.

Ideal pain management would attack pain development at most sites possible. The current clinical practice in the US applies a derivate of an opioid analgesic combined with acetaminophen, thereby influencing pain development at central perception by the opioid analgesic and acetaminophen and a peripheral analgesic effect of acetaminophen. The exact mechanism of the peripheral effect is not known.

This clinical practice disregards the positive effect of medications influencing the peripheral inflammatory response, namely nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs affect pain development by blocking the synthesis of arachidonic acid metabolites, inhibiting peripheral inflammatory response and central pain perception. The major reason for not applying NSAIDs in the treatment of acute fracture pain is an experimental animal study showing decreased bone healing in relation to NSAID usage.

However, clinical data thus far is inconclusive, whether bone healing is affected in humans and whether NSAIDs should be avoided in the setting of bone fractures.

This proposed study will give an answer whether the usage of NSAIDs in acute fractures has a negative effect on bone healing.


Sponsor: University of California, Davis

Current Primary Outcome: fracture healing as measured by radiographic evaluation [ Time Frame: 12 weeks ]

fracture healing at 12 weeks followup


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • pain level improvement as measured by VAS score [ Time Frame: 1 week, 2 weeks, 6 weeks, 9 weeks and 12 weeks ]
    VAS score
  • functional improvement as measured by AAOS score [ Time Frame: 1 weeks, 2 weeks 6 weeks, 9 weeks and 12 weeks ]
    AAOS scale


Original Secondary Outcome: Same as current

Information By: University of California, Davis

Dates:
Date Received: February 9, 2015
Date Started: January 2015
Date Completion: June 2017
Last Updated: February 20, 2015
Last Verified: February 2015