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NCT03054844

PREMIX vs PREMED Intranasal Lidocaine and Midazolam

Completed Phase 2 Results posted Last updated 11 September 2019
What this trial tests

Phase 2 trial testing Lidocaine in Pain in 55 participants. Completed in 10 October 2017.

Timeline
3 April 2017
Primary endpoint
10 October 2017
10 October 2017

Quick facts

Lead sponsorColumbia University
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposetreatment
Enrollment55
Start date3 April 2017
Primary completion10 October 2017
Estimated completion10 October 2017
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Columbia University

Who can join

Adults 6 Months to 7, any sex, with Pain. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Procedural Distress, OSBD-R Primary · 10 minutes

The Observational Scale of Behavioral Distress-Revised (OSBD-R) is an observational measure of pain and distress shown to have strong validity in children. The scale is an 8-factor, weighted observational scale used to measure distress associated with medical procedures, which has been validated in children and adults aged 1 to 20 years. The total Observational Scale of Behavioral Distress-Revised score is the sum of the scale scores for each phase, with each phase assigned a score from 0 to 23.5 units on a scale (0=no distress, 23.5=maximum distress), based on the frequency and types of behav

GroupValue95% CI
PREMED6.45 – 7.8
PREMIX75.2 – 8.9
Procedural Pain Secondary · 10 minutes

The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) utilizes six observational factors (cry, facial, verbal, torso, touch, and legs) to evaluate pain in young children and can be used to monitor the effectiveness of interventions for reducing the pain and discomfort of an intervention. This scale rates each behavior numerically, with a score of 4-6 units on a scale representing no pain, and a maximum score of 13 units on a scale representing (most pain perceived).

GroupValue95% CI
PREMED10.69.7 – 11.4
PREMIX10.59.5 – 11.4
Procedural Distress, FLACC Secondary · 10 minutes

The Faces, Legs, Activity, Cry, Consolability (FLACC) scale is comprised of five criteria (face, legs, activity, cry, consolability), with a possible score of 0 to 2 units on a scale for each criteria and a possible total score of 0 to 10 units on a scale (0 meaning no pain, 10 meaning most pain).

GroupValue95% CI
PREMED6.75.3 – 8.1
PREMIX75.4 – 8.6
Procedural Distress, Cry Duration Secondary · 10 minutes

Cry duration was measured in seconds and defined as the time from onset of crying following administration of an IN medication until the cessation of crying sounds and/or tears. If a patient did not cry, the cry duration was zero

GroupValue95% CI
PREMED8458 – 109
PREMIX7345 – 102
Parental Satisfaction Secondary · 1 minute

If my child needed medications to stay calm for a procedure, I would like to use these same medications again.

GroupValue95% CI
PREMED10
PREMIX12
Provider Satisfaction Secondary · 1 minute

I would like to use this method of administering intranasal midazolam and lidocaine again in the future

GroupValue95% CI
PREMED8
PREMIX24

Adverse events — posted to ClinicalTrials.gov

Time frame: Course of ED visit, typically between 1-2 hours. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

PREMED
Serious: 0/25 (0%)
Deaths: 0/25
PREMIX
Serious: 0/26 (0%)
Deaths: 0/26
Other adverse events (2 terms — click to expand)

ReactionSystemPREMEDPREMIX
VomitingGastrointestinal disorders
EpistaxisGeneral disorders

Data from ClinicalTrials.gov NCT03054844 adverse events section.

Sponsor's own description

Intranasal (IN) midazolam is an anxiolytic that is commonly used in the pediatric population for procedural anxiolysis in the emergency department (ED) setting to facilitate painful and distressing procedures, such as laceration repairs. Intranasal midazolam is both effective and safe in children. However, due to the acidic nature of midazolam, there is a burning sensation that is associated with the intranasal administration of midazolam. The use of IN lidocaine has been shown to decrease the pain associated with the administration of IN midazolam and other acidic solutions. The IN lidocaine can be given as a premedication (PREMED), where it is sprayed in the nares first to provide topical anesthesia, and then followed by the administration of the IN midazolam. Lidocaine can also be given concurrently with the IN midazolam (PREMIX), where it is mixed with the midazolam and then the combined mixture administered. Both methods have been shown to be effective in decreasing the pain associated with the intranasal administration of acidic solutions, such as midazolam, although the PREMIX method could have the advantage of requiring less number of sprays, and be tolerated better by children. Although both methods have been shown to work, it is not known if the PREMIX method is non-inferior to the PREMED method for decreasing pain and distress associated with administering IN midazolam. Therefore, the investigators aim to determine if the PREMIX method is non-inferior to the PREMED method of using lidocaine to decrease the pain and distress associated with the administration of IN midazolam in children.

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

  1. Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial.
    O'Connell NC, Woodward HA, Flores-Sanchez PL, McLaren SH, et al · · 2020 · cited 7× · PMID 33392564 · DOI 10.1002/emp2.12227

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Other trials of Lidocaine

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Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT03054844.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing