Oxycodone for Post-Operative Pain in Children

Recruiting in Palo Alto (17 mi)

Overseen by Patcharee Sriswasdi, MD

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 4

Recruiting

Sponsor: Boston Children's Hospital

Must not be taking: CYP3A4/2D6 inhibitors/inducers

Disqualifiers: Allergy to oxycodone, Gastrointestinal dysfunction, others

No Placebo Group

Prior Safety Data

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial studies how oxycodone, a pain medication, is processed in young children undergoing surgery. Researchers aim to understand how anesthesia affects the drug's absorption and metabolism, and how genetic differences might influence its effectiveness and side effects. Oxycodone is a semisynthetic opioid used for pain management, known for its prolonged duration of action and greater potency compared to morphine.

Do I need to stop my current medications for the trial?

Yes, you must stop taking any medications that are cytochrome P450 (CYP) 3A4 or 2D6 inhibitors or inducers to participate in this trial.

What data supports the effectiveness of the drug oxycodone for post-operative pain in children?

Research shows that oral oxycodone is effective for managing acute postoperative pain, as it is a commonly used opioid for such conditions. Additionally, a study found that oxycodone was effective in managing pain for pediatric outpatient wound care, indicating its potential usefulness in similar settings. ^{1 2 3 4 5}

Is oxycodone safe for children after surgery?

Research shows that controlled-release oxycodone is generally safe for children after surgery, with common side effects like dizziness, constipation, and nausea. It has been used safely in pediatric patients for pain management after spinal fusion surgery and outpatient wound care. ^{1 3 6 7 8}

How is the drug oxycodone unique for treating post-operative pain in children?

Oxycodone is unique for treating post-operative pain in children because it is an opioid that can be administered orally, providing effective pain relief, and there is ongoing research into its use intravenously, which has not been extensively studied in this context. ^{2 3 5 9 10}

Research Team

Patcharee Sriswasdi, MD

Principal Investigator

Boston Children's Hospital

Eligibility Criteria

This trial is for children aged 2-8 who are scheduled for specific in-patient surgeries (like hypospadias repair) at Boston Children's Hospital, have not used opioids before, and do not take certain other drugs or have liver, kidney, gastrointestinal issues, sleep apnea or allergies to oxycodone.

Inclusion Criteria

I am between 2-8 years old, need specific urinary tract surgery, and haven't taken opioids.

Exclusion Criteria

Known history of allergy to oxycodone

Speak a language other than English

I have been diagnosed with sleep apnea or have breathing issues.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 0.1 mg/kg of liquid oxycodone either before or after general anesthesia, with blood samples taken at 10 time points to study pharmacokinetics and pharmacogenomics

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with blood samples analyzed for pharmacokinetic parameters

24 weeks

Treatment Details

Interventions

• Oxycodone (Opioid Analgesic)

Trial Overview The study tests how general anesthesia affects the body's handling of liquid oxycodone in children. It compares the drug's effects when given at the start versus the end of anesthesia during surgery. The trial also includes genetic testing to understand different responses.

Participant Groups

Group I: Age 2-5 years-Before GA Active Control 1 Intervention

The group will include 25 patients (children 2-5 years old). In this group the children will be randomized to receive 0.1mg/kg of liquid oxycodone via an orogastric tube before the procedure at the beginning of general anesthesia (after intubation).

Group II: Age 2-5 years-After GA Active Control 1 Intervention

In this group 25 children will be randomized to receive 0.1mg/kg of liquid oxycodone via an orogastric tube after the procedure at the end of general anesthesia (before extubation).

Group III: Age 6-8 years-Before GA Active Control 1 Intervention

The group will include 25 patients (children 6-8 years old). In this group the children will be randomize to receive 0.1 mg/kg of liquid oxycodone orally before the surgery in pre-op holding.

Group IV: Age 6-8 years-After GA Active Control 1 Intervention

The group will include 25 patients (children 6-8 years old). In this group the children will be randomize to receive 0.1 mg/kg of liquid oxycodone orally after surgery in the Post Anesthesia Care Unit (PACU).

Oxycodone is already approved in Canada for the following indications:

Approved in Canada as OxyContin for:

• Moderate to severe pain

Who Is Running the Clinical Trial?

Boston Children's Hospital

Lead Sponsor

Trials

801

Recruited

5,584,000+

Dr. Kevin B. Churchwell

Boston Children's Hospital

Chief Executive Officer since 2021

MD from Vanderbilt Medical School

Dr. Sarah Pitts

Boston Children's Hospital

Chief Medical Officer since 2019

MD from Harvard Medical School

Findings from Research

In a study involving 22 pediatric patients aged 5-14, both oral transmucosal fentanyl citrate (OTFC) and oral oxycodone provided effective pain relief during outpatient burn wound care, with no significant side effects reported.

OTFC was preferred for its better taste, making it a more palatable option for children, while both medications demonstrated similar safety and efficacy profiles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. Sharar, SR., Carrougher, GJ., Selzer, K., et al.[2019]

Providing an oxycodone information sheet to parents significantly improved their satisfaction and knowledge regarding pain management after their child's tonsillectomy, leading to better pain control, especially noted on day 5 post-surgery (p<0.05).

The study highlights the importance of educational materials in enhancing postoperative analgesia management, suggesting that such information sheets should be routinely given to parents to ensure safer and more effective pain relief for children after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet. Bailey, L., Sun, J., Courtney, M., et al.[2018]

In a study of 79 patients undergoing thumb carpometacarpal arthroplasty or distal radius ORIF, the combination of oxycodone, acetaminophen, and ketorolac showed a trend towards better postoperative pain control and reduced opioid usage compared to other regimens.

Although not statistically significant, the group receiving oxycodone, acetaminophen, and ketorolac experienced fewer complications, suggesting that this combination may enhance safety and efficacy in managing postoperative pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-Modal Pain Control in Ambulatory Hand Surgery. Harrison, RK., DiMeo, T., Klinefelter, RD., et al.[2018]

In a study involving 66 children aged 6-18 with orthopedic injuries, oxycodone, ibuprofen, and their combination all effectively reduced pain, but there were no significant differences in pain relief among the three treatment groups.

The combination of oxycodone and ibuprofen led to more adverse effects, suggesting that using either medication alone is preferable to minimize side effects while still providing effective pain relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children. Koller, DM., Myers, AB., Lorenz, D., et al.[2013]

Oral oxycodone is effective for managing acute postoperative pain, showing superior analgesic efficacy compared to placebo and comparable or better pain relief than intravenous opioids in various surgical procedures, including knee arthroplasty and laparoscopic surgeries.

Patients using oral oxycodone experienced fewer side effects than those on other opioids, did not have prolonged hospital stays, and had lower overall drug costs, making it a safe and reasonable alternative for postoperative pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials. Cheung, CW., Ching Wong, SS., Qiu, Q., et al.[2018]

A study of 62 pediatric patients (ages 10-19) showed that controlled-release oxycodone (oxycodone-CR) is safe and effective for managing pain after spinal fusion surgery, with pain scores decreasing from 4.2 to 3.7 out of 10.

Patients transitioned to oxycodone-CR after the immediate postoperative period, using it for an average of 13.3 days, and experienced common side effects like dizziness, constipation, and nausea, indicating a manageable safety profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Controlled-release oxycodone for the management of pediatric postoperative pain. Czarnecki, ML., Jandrisevits, MD., Theiler, SC., et al.[2019]

Oxycodone, a commonly used opioid for moderate-to-severe pain, has a higher bioavailability and longer half-life compared to oral morphine, which is important for its effective use in various patient populations.

The pharmacokinetics of oxycodone can vary significantly among individuals, especially in special populations like children and those with liver or renal failure, highlighting the need for careful dosing to maximize pain relief while minimizing side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The pharmacokinetics of oxycodone. Lugo, RA., Kern, SE.[2022]

The new oxycodone 10-mg/acetaminophen 325-mg formulation (Percocet) was found to be more effective than a higher dose of oxycodone alone in managing acute pain after oral surgery, based on a study of 141 patients.

This combination not only provided faster pain relief but also resulted in fewer treatment-related side effects, highlighting its potential as a safer alternative for pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized, double-blind, placebo-controlled comparison of the analgesic efficacy of oxycodone 10 mg/acetaminophen 325 mg versus controlled-release oxycodone 20 mg in postsurgical pain. Gammaitoni, AR., Galer, BS., Bulloch, S., et al.[2019]

Intravenous oxycodone provides adequate postoperative pain relief in pediatric patients, similar to tramadol, but with less sedation and a shorter recovery time in the post-anesthesia care unit (PACU).

Both oxycodone and tramadol had comparable side effects, primarily nausea and vomiting, indicating that oxycodone may be a safer alternative for managing acute postoperative pain in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oxycodone vs. tramadol in postoperative parent-controlled intravenous analgesia in children: a prospective, randomized, double-blinded, multiple-center clinical trial. Li, S., Xiong, H., Jia, Y., et al.[2023]

In a study of 166 children undergoing endoscopic plasma total adenotonsillectomy, preemptive analgesia with a low dose of oxycodone (0.1 mg/kg) significantly reduced postoperative pain compared to standard sufentanil treatment.

The use of preemptive oxycodone resulted in lower serum c-fos levels and better pain management outcomes, as indicated by lower Pediatric Anesthesia Emergence Delirium (PAED) scores and FLACC scores at 24 hours post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oxycodone preemptive analgesia after endoscopic plasma total adenotonsillectomy in children: A randomized controlled trial. Wu, J., Gui, Q., Wang, J., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. [2019]

2. Ireland pubmed.ncbi.nlm.nih.gov

Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Multi-Modal Pain Control in Ambulatory Hand Surgery. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children. [2013]

5. United States pubmed.ncbi.nlm.nih.gov

Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Controlled-release oxycodone for the management of pediatric postoperative pain. [2019]

7. England pubmed.ncbi.nlm.nih.gov

The pharmacokinetics of oxycodone. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Randomized, double-blind, placebo-controlled comparison of the analgesic efficacy of oxycodone 10 mg/acetaminophen 325 mg versus controlled-release oxycodone 20 mg in postsurgical pain. [2019]

9. England pubmed.ncbi.nlm.nih.gov

Oxycodone vs. tramadol in postoperative parent-controlled intravenous analgesia in children: a prospective, randomized, double-blinded, multiple-center clinical trial. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Oxycodone preemptive analgesia after endoscopic plasma total adenotonsillectomy in children: A randomized controlled trial. [2022]