- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01795287
Safety of Spinal Anesthesia in Patients With Tibial Shaft Fracture
Safety of Spinal Anesthesia in Patients With Tibial Shaft Fracture: A Single-center Randomized, Controlled Trial.
There is a elevated risk of acute compartment syndrome (ACS) related to tibial shaft fractures due to oedema and reduced blood flow in traumatised tissues. This may lead to lack of oxygen and even necrosis. Symptoms of ACS are severe pain, hypoaesthesia, pain during flexion of the ankle and swollen leg in clinical examination. Paralysis and lack of distal pulses are late symptoms of ACS.
Many experts think that effective relief of pain caused by regional anaesthesia (RA) may hide the symptoms of the ACS. This may be incorrect. The evidence of dangers related to RA is based on old patient-series and single case-reports. Some of these studies report the symptoms of ACS (hypaesthesia and even pain) being caused by RA. Majority of the conclusions in these studies cannot be confirmed by an expert of RA. It is also possible that there are more hemodynamic changes related to general anaesthesia (GA) which may predispose to ACS. There are no modern, randomized and controlled studies of the safety of RA in patients with tibial shaft fracture.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
For some of the patients RA may be even more safe than GA. According to a large meta-analysis RA reduces the risk of several complications versus GA.
- Risk of deep vein thrombosis is reduced by 44%
- Risk of pulmonary embolism is reduced by 55 %
- Risk of major bleeding is reduced by 50%
- Risk of post operative pneumonia is reduced by 39%
- Risk of post operative respiratory is reduced by 59%
It is generally thought that RA is safer than GA for example in patients with heart or pulmonary diseases. It is also known that the use of RA reduces postoperative need of opioids, which leads to improved respiratory function and reduced post operative disorientation, delirium and nausea.
Purpose of the study: Our purpose is to gain more information of the safety of RA in patients with tibial fracture. Our hypothesis is that RA is equally safe with GA.
Implementation: Research begins with a pilot study in which RA is compared with GA. There are about 65 tibial fractures operated in our centre every year. We randomize patients to GA group (n=25) and spinal anaesthesia group (n=25). We presume that RA is equally safe with GA. However, power analysis has been made presuming that RA will increase the risk of ACS. We calculated the sample size by assuming that the compartment pressure in RA group is 10 mmHg higher than in the GA group.
GA will be inducted by fentanyl, propofol and rocuronium. GA will be maintained by sevofluran, fentanyl and rocuronium. Spinal-anaesthesia will be performed by using hyperbaric bupivacaine. The dose is 10-15 mg, depending on the needs of the patient. This will maintain RA in lower extremities for 2-4 hours, which is enough to operate a tibial shaft fracture. In both study groups the post-operative pain will be treated by intravenous and peroral oxycodone and paracetamol.
Monitoring and ethics:
- Clinical examination every hour in recovery room (oedema, temperature, cutaneous sensation, distal pulses)
- Continuous pressure-measurement of anterior compartment in the operated leg for 24 hours
- Local oxygen metabolism measured by near-infrared spectroscopy in the operated leg for 24 hours
Patients will be monitored in the recovery room for 24 hours after operation. Blood tests (creatine kinase and myoglobin) will be drawn before operation, when arriving in recovery room, 6 hours and 24 hours after operation in each patient.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Timo Kaakinen, MD, PhD
- Phone Number: +358405939190
- Email: timo.kaakinen@fimnet.fi
Study Contact Backup
- Name: Merja Vakkala, MD, PhD
- Phone Number: +358442915787
- Email: merja.vakkala@ppshp.fi
Study Locations
-
-
-
Oulu, Finland, 90029
- Recruiting
- Oulu University Hospital
-
Contact:
- Timo Kaakinen, MD, PhD
- Phone Number: +358405939190
- Email: timo.kaakinen@fimnet.fi
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Patients with a unilateral tibial shaft fracture which needs to be operated are included.
Exclusion Criteria:
- refusal of the patient
- severe, generalized atherosclerosis
- massive obesity
- marked mental retardation, dementia
- bilateral tibial shaft fracture
- polytrauma, such as head injury
- bleeding diathesis
- aortic stenosis
- infection at the injection site
- certain medications affecting bleeding
- sepsis
- hypovolemia
- conversion to general anaesthesia due to technical difficulties
- anesthesiologist has a strong opinion towards GA/RA
- foreign patient and marked translation difficulties
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Spinal anesthesia
|
GA will be inducted by fentanyl, propofol and rocuronium.
GA will be maintained by sevofluran, fentanyl and rocuronium.
hyperbaric bupivacaine 10-15 mg i.t.
|
Active Comparator: General anesthesia
General anesthesia with fentanyl, propofol and rocuronium and sevoflurane
|
GA will be inducted by fentanyl, propofol and rocuronium.
GA will be maintained by sevofluran, fentanyl and rocuronium.
hyperbaric bupivacaine 10-15 mg i.t.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Compartment pressure
Time Frame: 0-24 hours after surgery
|
Continuous measurement of anterior compartment pressure in the operated leg
|
0-24 hours after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
INVOS values after surgery
Time Frame: 0-24 hours after surgery
|
Continuous monitoring of INVOS values in the anterior and postolateral position in the operated leg
|
0-24 hours after surgery
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Timo Kaakinen, MD, PhD, Oulu University Hospital
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- kaakinen001
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Tibial Fracture
-
Synthes GmbHCompletedClosed Proximal Tibial Fracture Schatzker I - VI | Closed Proximal Tibial Fracture AO-OTA 41 | Closed Proximal Tibial Fracture AO-OTA 42Korea, Republic of
-
Peter KlimekMedical Research Council Kantonsspital Aarau, SwitzerlandCompleted
-
Bone Therapeutics S.AICON plcRecruitingTibial FractureBelgium, Czechia, France, Germany, Hungary, Poland, Spain
-
Hadassah Medical OrganizationTeva Branded Pharmaceutical Products R&D, Inc.Completed
-
Hadassah Medical OrganizationSuspended
-
BONESUPPORT ABCompletedTibial FractureUnited States, United Kingdom, Germany, Poland
-
University of MinnesotaNational Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)Completed
-
Royan InstituteCompletedTibial FractureIran, Islamic Republic of
-
Aeos Biomedical Inc.TerminatedFemoral Fracture | Tibial FractureCanada
-
Pedro-José Torrijos-GarridoRecruitingTibial Plateau FractureSpain
Clinical Trials on General anesthesia
-
Peking University First HospitalPeking University; Peking University People's Hospital; Peking University Third... and other collaboratorsCompletedElderly | Long-term Outcome | Malignant Tumor | Epidural Anesthesia | Surgical ResectionChina
-
Boston Children's HospitalFood and Drug Administration (FDA); Royal Children's Hospital; Murdoch Childrens... and other collaboratorsCompletedInguinal HerniaUnited States, Canada, Australia, Italy, United Kingdom, Netherlands, New Zealand
-
Ohio State University Comprehensive Cancer CenterRecruitingPancreatic AdenocarcinomaUnited States
-
University of Lausanne HospitalsWithdrawn
-
Peking University First HospitalPeking University People's Hospital; Peking University Third Hospital; Beijing... and other collaboratorsCompletedLong-term Outcome | Elderly Patients | Epidural Anesthesia | Solid Organ Cancer | Surgical ResectionChina
-
University of PennsylvaniaPatient-Centered Outcomes Research InstituteActive, not recruitingHip FracturesUnited States, Canada
-
Peking University First HospitalCompletedNeoplasm Metastasis | Lung Cancer | Thoracic Surgery | Anesthesia, Epidural | Neoplasm Recurrence, LocalChina
-
Second Affiliated Hospital of Wenzhou Medical UniversityRecruitingDepression, AnxietyChina
-
Queen Fabiola Children's University HospitalRecruiting
-
General Hospital of Ningxia Medical UniversityNot yet recruitingShoulder Injuries | Shoulder OsteoarthritisChina