- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03063671
Dexmedetomidine,Ketamine and Their Combination to Bupivicaine on Thoracic Epidural Analgesia
Effect of Adding Dexmedetomidine, Ketamine and Their Combination to Bupivicaine in Thoracic Epidural Analgesia on Post-mastectomy Pain
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Breast cancer is the most common cancer diagnosed in Egyptian women. Many modalities are used in the treatment of breast cancer including chemotherapy, radiotherapy or surgical intervention. Nowadays, surgical intervention is more conservative.Modified radical mastectomy (MRM) is the standard surgical procedure of choice in these patients. MRM is usually performed under general anesthesia, almost always combining intravenous and inhalational agents.The drawback of general anesthesia includes inadequate pain control due to lack of analgesia, high incidence of nausea and vomiting, stress of anesthesia and surgery, and increasing the length of hospital stay.Post mastectomy pain is a pain which occur following breast cancer procedures, particularly those operations that remove tissues in upper outer quadrant of breast and/or axilla. This pain can be severe enough to cause long term disabilities and interfere with sleep, performance of daily activities. Also, it can seriously affect the patient mood, and social functions.
Thoracic epidural analgesia (TEA) faces growing interest as adjuvant anesthetic and post-operative analgesic regimen. the use of adjuvant drug with local anesthetic is essential as it prolongs the duration of action, gives better success rate and increases patient satisfaction.
Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, not only abolishes peripheral afferent noxious stimulation, but it can also prevent the central sensitization of nociceptors. When added to epidural local anesthetics, ketamine appears to have adjuvant effects. Dexmedetomedine is a selective, α2-adrenoceptor agonist with analgesic potency, sedative properties, and minimal respiratory depression when used as an adjuvant to regional anesthesia.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Assuit, Egypt
- South Egypt Cancer Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients scheduled for modified radical mastectomy.
- ASA Physical status I, II and III.
Exclusion Criteria:
- Patients' refusal.
- Uncooperative patients & severe psychiatric illness (cannot evaluate their own pain intensity using visual analogue scale (VAS).
- Patients with history of drug allergy.
- severe renal or liver impairment, unstable ischemic heart disease
- Any contraindications to epidural analgesia (coagulopathy, recent -less than 1 week-treatment with thrombolytic or potent antiplatelet drugs as clopidogrel, and local infection).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: bupivacine group
preoperative insertion of thoracic epidural at T4-5 and adminstration of 12 ml bupivacine 0.125% as one shot 15 minutes before general anesthesia postoperative analgesia done by infusion of bupivacaine 0.125% (5ml/hour through thoracic epidural catheter for 12 hours).
|
thoracic epidural catheter insertion at T4-5
|
Active Comparator: ketamine group
preoperative insertion of thoracic epidural at T4-5 and adminstration of 12 ml bupivacine 0.125% plus ketamine in a dose 0.5 mg/kg 15 minutes before general anesthesia postoperative analgesia will be preformed by infusion of mixture of (bupivacaine 0.125% plus ketamine 0.5 mg/ml ml) in a rate of 5ml/hour through thoracic epidural catheter for 12 hours
|
thoracic epidural catheter insertion at T4-5
|
Active Comparator: dexmedetomidine group
preoperative insertion of thoracic epidural at T4-5 and adminstration of 12 ml bupivacine 0.125% plus dexmedetomidine in a dose 1 ug/kg 15 minutes before general anesthesia Postoperative analgesia will be performed using infusion of mixture of (bupivacaine 0.125% plus dexmedetomedine 2μg/ ml) in a rate of 5ml/hour through thoracic epidural catheter for 12 hours.
|
thoracic epidural catheter insertion at T4-5
|
Active Comparator: ketamine-dexmedetomidine group
preoperative insertion of thoracic epidural at T4-5 and adminstration of 12 ml bupivacine 0.125% plus both ketamine in a dose 0.3 mg/kg and dexmedetomidine in a dose 0.1 ug/kg 15 minutes before general anesthesia Postoperative analgesia will be performed using infusion of mixture of (bupivacaine 0.125% plus dexmedetomedine 2μg/ ml and and ketamine 0.5 mg/ml) in a rate of 5ml/hour through thoracic epidural catheter for 12 hours.
|
thoracic epidural catheter insertion at T4-5
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
total dose of intravenous morphine consumption in the first 48 hours post operatively
Time Frame: 48 hours postoperative
|
total dose of intravenous morphine comsumption
|
48 hours postoperative
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual analogue scale
Time Frame: 0, 2,4,6,8,18,36,48 hours
|
Visual analogue scale will be assessed at rest and on movement (abduction of the ipsi-lateral arm).
|
0, 2,4,6,8,18,36,48 hours
|
MAP
Time Frame: 0,30,60,120,150 minutes
|
mean arterial blood pressure
|
0,30,60,120,150 minutes
|
HR
Time Frame: 0,30,60,120,150 minutes
|
heart rate
|
0,30,60,120,150 minutes
|
sedation score
Time Frame: 0, 2,4,6,8,18,36,48 hours
|
sedation sore using sedation scale where; 0 = aware - 1 = drowsy - 2 = asleep/easily respond to verbal command - 3 = asleep/difficulty responding to verbal command -4 = asleep/no respond to verbal command
|
0, 2,4,6,8,18,36,48 hours
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pain
- Neurologic Manifestations
- Acute Pain
- 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, Dissociative
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Ketamine
- Dexmedetomidine
Other Study ID Numbers
- 110
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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 Acute Pain
-
Rajavithi HospitalCompletedTotal Abdominal Hysterectomy ,Pain , Acute Postoperative,Gabapentin , CelecoxibThailand
-
Schulthess KlinikNot yet recruiting
-
Seoul National University HospitalNot yet recruiting
-
Chung-Ang University Gwangmyeong HospitalRecruitingPostoperative Pain, AcuteKorea, Republic of
-
TC Erciyes UniversityCompletedPostoperative Pain, AcuteTurkey
-
Zagazig UniversityRecruiting
-
Mansoura UniversityRecruitingPostoperative Pain, AcuteEgypt
-
University of California, San DiegoActive, not recruitingPostoperative Pain, AcuteUnited States
-
Umraniye Education and Research HospitalNot yet recruiting
-
Sohag UniversityCompletedPostoperative Pain, AcuteEgypt
Clinical Trials on Ketamine, bupivacine,dexmedetomidine
-
Ciusss de L'Est de l'Île de MontréalRecruiting
-
Guangzhou Women and Children's Medical CenterSuspendedIntranasal Ketamine With Dexmedetomidine for the Treatment of Children With Autism Spectrum DisorderAutism Spectrum DisorderChina
-
Eye & ENT Hospital of Fudan UniversityCompletedPain, Procedural | Emotions | Separation AnxietyChina
-
Ain Shams UniversityCompletedUpper Gastrointestinal EndoscopyEgypt
-
Naveen PoonaiRecruitingFracture | DislocationCanada
-
Zagazig UniversityCompleted
-
Assiut UniversityNot yet recruitingEmergence Delirium | SedationEgypt
-
Tanta UniversityCompleted
-
The First Affiliated Hospital with Nanjing Medical...Not yet recruitingAnalgesia | Ketamine | Dexmedetomidine | Mechanical Ventilation | Intensive Care UnitsChina
-
Universidade Federal de GoiasFundação de Amparo a Pesquisa do Estado de Goias (FAPEG)CompletedDental Anxiety | Caries of InfancyBrazil