- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02903901
Melatonin for Prevention of Post- Operative Delirium Pilot Study Protocol
To test the efficacy of melatonin compared to placebo in preventing post-operative delirium and reduction in intensity or duration of delirium in individuals 65 years of age and older who undergo orthopedic surgery after low energy lower extremity fractures (LELEF).
Biomarkers may play important roles in the detection, prediction and management of delirium especially in frail elderly individuals. Predictive biomarkers may help characterize an individual's susceptibility to delirium and thereby help specialized treatment, care and management of such individuals during their hospitalization. They may also help predict treatment response to a specific modality and help in selection of such modality. Recent studies performed in the UK and published in 2011 have measured plasma cholinesterase activity and determined that these levels were lower in patients who developed delirium compared with remaining subjects. Other studies have indicated that CRP may also have a role in delirium prediction as they have found that CRP measured on admission to an ICU had predictable changes that occurred within 24 hours that in turn were predictors of delirium. One the aims of the study is to compare the predictive and treatment response values of groups of biomarkers that have been hypothesized to be of predictive value.
Study Overview
Detailed Description
Surgery causes oxidative stress on the brain9 leading to inflammation. Post-operative delirium has been linked with inflammation in the brain. Delirium has been hypothesized to be a central nervous system response to systemic inflammation during a state of blood-brain barrier (BBB) compromise.
Studies have shown a rise of inflammatory cytokines and fall of anti-inflammatory cytokines. Vice-versa, external cytokine administration has been shown to lead to delirium. Melatonin is known for its strong anti-oxidant and anti-inflammatory properties, this should account for its preventive properties in post-operative delirium. It has also been hypothesized that post-operative delirium in elderly is caused by circadian rhythm disturbances secondary to a relative lack of melatonin.
Keeping in mind the above two possible pathophysiology for delirium, investigators are expecting melatonin supplementation should be able to reduce the incidence of post-operative delirium particularly in elderly population.
Study Type
Phase
- Phase 4
Contacts and Locations
Study Locations
-
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Illinois
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Maywood, Illinois, United States, 60153
- Loyola University Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients 65 years of age and older undergoing Low Energy Lower Extremity Fractures (LELEF) surgery
- Presence of an LELEF fracture
- Low Energy (e.g., falls from standing height, falls from sitting, etc.).
Operative Fractures:
- Pathologic femur and tibia fractures
- Femoral neck fractures
- Pertroch: including intertroch, subtroch fractures
- Femoral shaft
- Supracondylar femur fractures
- Periprosthetic fractures around total hip and total knee arthroplasties
- Tibial plateau fractures
- Proximal Tibia Fractures
- Tibial Shaft Fractures
- Distal 1/3 tibia fractures
- Ankle Fractures that are admitted
Exclusion Criteria:
- Patients with previous adverse reaction or side-effects to melatonin
- Inability or unwillingness of individual or legal guardian/representative to give written informed consent.
- Inability to communicate in English
- Patients with a Montreal Cognitive Assessment (MoCA) score of below 7 will not be included in the study because of their inability to give informed consent at that stage. This score is approximately 2 standard deviation below average score for Alzheimer's Dementia.
- Participants who are unable to give consent or communicate well in English will not be enrolled
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Individuals who are randomized to the control arm will receive liquid placebo sublingually 60-90 minutes prior to surgery.
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10 mg liquid placebo at 7 pm for 1 week
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Active Comparator: Melatonin
Individuals who are randomized to the treatment arm will receive 10 mg liquid IR-SL melatonin 60-90 minutes prior to surgery
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10 mg liquid Melatonin IR-SL at 7 pm for 1 week
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Delirium assessment
Time Frame: 1 Week
|
The Delirium Rating Scale Revised (DRS-R98) will be given to all patients every day for seven days.
Investigators will compare the scores recorded on day 7 between those receiving melatonin versus those receiving placebo controlling for their baseline performance.
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1 Week
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hospital stay
Time Frame: 1 Week
|
Length of hospital stay will be recorded for all patients and compared between the two treatment groups (i.e., those receiving melatonin and those receiving placebo).
|
1 Week
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Muralidhara S Rao, MD, Loyola University
Publications and helpful links
General Publications
- Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009 Dec;103 Suppl 1(Suppl 1):i41-46. doi: 10.1093/bja/aep291.
- Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol. 2003 Jun;17(2):259-72. doi: 10.1016/s1521-6896(03)00005-3.
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 (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 206981
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.
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