Spinal or Intravenous Dexmedetomidine in Ambulatory Surgery

Influence of Spinal or Intravenous Dexmedetomidine on Spinal Anesthesia With Chloroprocaine and Bladder Function in Day-case Surgery. A Double Blind Randomized Study.

The primary objective of this double blind randomized study is to determine the effect of dexmedetomidine on onset and duration of the sensory and motor block and on the influence on bladder function after spinal anesthesia with chloroprocaine. Our primary hypothesis is that sensory block will significantly be prolonged by dexmedetomidine administered by both the spinal and the intravenous route. The investigators do not expect a significant difference in motor block duration between intravenous or spinal administration. Secondary outcomes are micturition problems, duration of analgesia and the occurrence of side effects such as sedation and hypotension.

Study Overview

• Status: Completed
• Conditions: Surgery Ambulatory
• Intervention / Treatment: Other: spinal chloroprocaine 40 mg; Drug: spinal dexmedetomidine 0.5 mcg; Drug: IV dexmedetomidine 0.5 mcg/kg

Detailed Description

The study is designed as a multicenter study and randomization and inclusion of patients will be performed in three hospitals. Each hospital has its own randomisation sequence and coordinating investigator who will be responsible for appointing blinded and unblinded participators in the study.

Patients scheduled for spinal anesthesia in ambulatory surgery will be randomized by sealed envelopes (computer generated sequence) into one of the following three study groups:

spinal chloroprocaine 40 mg with spinal dexmedetomidine (5mcg) spinal chloroprocaine 40 mg with intravenous dexmedetomidine ( 0.5 mcg/kg) spinal chloroprocaine 40 mg alone (control group)

All patients will receive the same amount of spinal solution, containing chloroprocaine 1% (4 ml) with dexmedetomidine (0.5 ml, 1 mcg/ml) or NaCl ( sodiumchloride) 0,9% (0.5 ml ) ( and 50 ml intravenous Nacl 0.9, containing dexmedetomidine (0.5 mcg/kg) or not depending on the study group. All solutions are prepared by an independent anesthesiologist and labelled as Intravenous study medication and spinal study medication. Spinal anesthesia and data registration will be done by a blinded anesthesist and/or study nurse on a data sheet designed for the study.

Spinal anesthesia is performed in the lateral decubitus at L3-L4 vertebral interspace and standard monitoring for this procedure is applied. Insufficient analgesia will be treated with sufentanil increments. Hypotension and bradycardia will be treated with ephedrine and atropine. Patients will be discharged when the block is regressed, there is no sedation or nausea and nrs scores of pain are below 4. Patients will be contacted by telephone after one week to evaluate any postoperative complaints.Micturition will receive a score based on bladder volumes measured by bladder scanning and subjective complaints . This score system was used in two of our former studies (1,2)

To calculate the power of this study, we used the mean L2 regression of a previous study after spinal chloroprocaine with its standard deviation (SD 20 min, mean 90 min) and compared it to a mean increase with 30 %. We calculated that we should include 7 patients in each group to obtain a power of 80%.

To be sure to detect a possible difference in discharge time as well, we calculated a sample size of 48 patients for each group to detect a 30-minute difference.

Statistical analysis will be done with ANOVA analysis , A kruskal-Wallis of Mann Whitney test depending on the distribution of the population and if the values are parametric or not. This will be done by spss.

• Study Type: Interventional
• Enrollment (Anticipated): 150
• Phase: Phase 4

Contacts and Locations

Study Locations

• Belgium
  • Antwerp, Belgium, 2650
    • University hospital Antwerp
  • Wilrijk, Belgium, 2610
    • Sint Augustinus

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• ASA (American Society of Anesthesiologists) class 1 & 2,
• undergoing day-case knee arthroscopy

Exclusion Criteria:

• micturition problems,
• neurological history or
• previous lower abdominal surgery with an abnormal micturition

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: A chloro; spinal chloroprocaine 40 mg	Other: spinal chloroprocaine 40 mg; spinal anesthesia with chloroprocaine 40 mg; Other Names: ampres
Experimental: B chloro+ spin dexdor; Spinal chloroprocaine 40 mg spinal dexmedetomidine 0.5 mcg	Other: spinal chloroprocaine 40 mg; spinal anesthesia with chloroprocaine 40 mg; Other Names: ampres; Drug: spinal dexmedetomidine 0.5 mcg; Administration of dexmedetomidine 0.5 mcg; Other Names: dexdor
Experimental: C chloro + IV dexdor; Spinal chloroprocaine 40 mg IV dexmedetomidine 0.5 mcg/kg	Other: spinal chloroprocaine 40 mg; spinal anesthesia with chloroprocaine 40 mg; Other Names: ampres; Drug: IV dexmedetomidine 0.5 mcg/kg; intravenous administration of dexmedetomidine 0.5 mcg/kg; Other Names: dexdor

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
sensory block regression L2 dermatome (minutes) (Time from injection until First time registration of loss of cold sensation)	Time from injection until First time registration of loss of cold sensation at the L2 dermatome during block regression. Loss of cold sensation will be regularly assessed from spinal injection until total regression of the sensory block	up to 360 minutes
Motor block regression (minutes) (time from injection until achievement of active knee movement)	time from injection until achievement of active knee movement during block regression. Motor block will be assessed at regular intervals from spinal injection untill total regression of the motor block	up to 240 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
discharge time (minutes)	time from spinal injection until achievement of discharge criteria	up to 240 minutes
time to micturition ( minutes)	time from injection until first voiding	up to 240 minutes
blood pressure drop	percentage of drop blood pressure compared to base line ( measured before spinal injection) . Blood pressure will be measured at regular intervals from just prior to spinal injection until discharge	up to 240 minutes

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
micturition problems (scaling based on bladder volumes and subjective difficulties) in a 1-5 point scale	classification of problems ( scaling based on bladder volumes and subjective difficulties) in a 1-5 point scale	at discharge ( up to 240 minutes)

Collaborators and Investigators

• Sponsor: University Hospital, Antwerp
• Investigators: Principal Investigator: margaretha breebaart, MD, University Hospital, Antwerp; Principal Investigator: Marcel Vercauteren, MD, PHD, University Hospital, Antwerp

Publications and helpful links

General Publications

• Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine. Br J Anaesth. 2003 Mar;90(3):309-13. doi: 10.1093/bja/aeg078.
• Breebaart MB, Teune A, Sermeus LA, Vercauteren MP. Intrathecal chloroprocaine vs. lidocaine in day-case surgery: recovery, discharge and effect of pre-hydration on micturition. Acta Anaesthesiol Scand. 2014 Feb;58(2):206-13. doi: 10.1111/aas.12247.

Study record dates

Study Major Dates

• Study Start: October 1, 2014
• Primary Completion (Actual): December 1, 2020
• Study Completion (Actual): December 1, 2020

Study Registration Dates

• First Submitted: October 30, 2014
• First Submitted That Met QC Criteria: November 3, 2014
• First Posted (Estimate): November 4, 2014

Study Record Updates

• Last Update Posted (Actual): August 5, 2022
• Last Update Submitted That Met QC Criteria: August 4, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: spinal or intravenous dexmedetomidine
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Adrenergic Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anesthetics; Analgesics, Non-Narcotic; Adrenergic alpha-2 Receptor Agonists; Adrenergic alpha-Agonists; Adrenergic Agonists; Hypnotics and Sedatives; Anesthetics, Local; Dexmedetomidine; Chloroprocaine
• Other Study ID Numbers: 13/35/334