- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04306159
Application of Rectus Sheath Block based-on Incision in Upper Abdominal Surgery
August 22, 2021 updated by: The First Affiliated Hospital of Anhui Medical University
Application of Opioid-sparing Multimodal Anesthesia Based on Rectus Sheath Block in Open Upper Abdominal Surgery:A Randomized Controlled Study
General anesthesia combined subcostal transversus abdominis plane (TAP)or rectus sheath block (RSB)can significantly reduce the use of opiates in minimally invasive surgery.However, similar reduction was not observed in open abdominal surgery during perioperative period.Therefore, the investigators should try to improve the blocking methods to reduce the side effects of a large number of opiates.
Based on the range and its analgesic effect of various nerve block is obviously related to the injection site of local anesthetics, this randomized controlled study hypothesized that modified RSB under the guidance of surgical incision may be more effective in inhibiting the harmful stimulation of surgery.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
For abdominal cancer surgery with midline incision, subcostal transversus abdominis plane or rectus sheath block combined with general anesthesia was more effective in reducing pain scores and opioid consumption compared with general anesthesia alone.
However, there was no statistically significant difference in supplementary fentanyl during operation.
Besides adequate pain relief around incisions, blunting visceral traction response has also an important role in hemodynamic stability.With the evidences for a potential mechanism for the antinociceptive effects of propofol on visceral nociception and dexmedetomidine combined with oxycodone can provide good visceral analgesia, the investigators supposed that visceral nociception was well suppressed by adequate antinociceptive drugs.
The propofol combination with dexmedetomidine may had significant effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate.
Study Type
Interventional
Enrollment (Actual)
126
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Anhui
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Hefei, Anhui, China
- The First Affiliated Hospital of Anhui Medical University
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 85 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Aged 18-85 years
- Anesthesiologists (ASA) risk classification I to IV
- Scheduled to undergo midline incision of upper abdomen (From xiphoid to navel )
Exclusion Criteria:
- Patient refusal
- Any contraindications to regional techniques (allergy to local anesthetics, infection around the site of the block, and coagulation disorder)
- History of analgesics dependence
- Any difficulty with communication
- Allergy to the study drugs
- Heat rate < 50 beats/minutes or II-III Atrioventricular block
- Previous open surgery
- Previous definite history of malignant tumor
- Who had an estimated intraoperative blood loss of more than 500 mL
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Sham Comparator: General anesthesia
Basal blood pressure and heart rate were recorded after midazolam administration of 0.02 mg/kg.
Anesthesia was induced with sufentanil 0.4 μg/kg and propofol 2-2.5 mg/kg, IV route.
An IV bolus of cisatracurium 0.1 mg/kg IV was given to facilitate tracheal intubation.
Anesthesia was maintained with propofol 4-6 mg/kg/h combined dexmedetomidine 0.2 μg/kg/h(after 0.2 μg/kg/h loading dose within 15min)by bispectral index (BIS) 40-60 and additional bolus doses of remifentanil 0.2-0.5 μg/kg/min to keep arterial pressure values around 20% below baseline values.
Sufentanil 0.1-0.2
μg/kg and flurbiprofen 100mg was administrated once the abdomen was closed, then a patient controlled analgesia pump was used.
No RSB was performed.
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Traditional general anesthesia management
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Experimental: Subcostal TAP combined with General anesthesia
After induction, TAP was performed.
The transversus abdominis plane is imaged with the ultrasound probe obliquely on the upper abdominal wall, along the subcostal margin near the midline.The needle tip was advanced to the desired position where 20 mL 0.375%ropivacaine(Dexamethasone 5mg was added)were injected.The technique is repeated on the opposite side.
Anesthesia method and management was same as general anesthesia group.
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Subcostal transversus abdominis plane block
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Experimental: Modified RSB combined with General anesthesia
After induction, Modified RSB was performed based on midline incision-guided.
The rectus muscle is imaged with the ultrasound probe in a transverse orientation below the xiphisternum and above the umbilicus.The needle tip was advanced to the two desired position where 10 mL ropivacaine 0.375% were injected causing hydrodissection of the rectus muscle away from the posterior rectus sheath.The technique is repeated on the opposite side.Anesthesia method and management was same as general anesthesia group.
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Rectus Sheath Block under the guidance of surgical incision
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opiate consumption
Time Frame: From the beginning to the end of anesthesia,up to 6 hours.
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Remifentanil consumption
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From the beginning to the end of anesthesia,up to 6 hours.
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Tumor recurrence rate
Time Frame: 1-year after surgery
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Tumor recurrence rate after surgery
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1-year after surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opiate consumption
Time Frame: From the end of anesthesia to 48 hours after surgery, up to 2 days.
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Sufentanil consumption
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From the end of anesthesia to 48 hours after surgery, up to 2 days.
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Pain scores
Time Frame: 2 hours after surgery
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2 hours after surgery
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Pain scores
Time Frame: 6 hours after surgery
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6 hours after surgery
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Pain scores
Time Frame: 12 hours after surgery
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12 hours after surgery
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Pain scores
Time Frame: 24 hours after surgery
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24 hours after surgery
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Pain scores
Time Frame: 36 hours after surgery
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36 hours after surgery
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Pain scores
Time Frame: 48 hours after surgery
|
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48 hours after surgery
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Time for first to press pump
Time Frame: Up to 2 days after surgery
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Time for first to press pump
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Up to 2 days after surgery
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Time of anal exsufflation
Time Frame: Up to 7 days after surgery
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Time for first anal exsufflation
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Up to 7 days after surgery
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Delirium
Time Frame: Up to 7 days after surgery
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Incidence of postoperative delirium
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Up to 7 days after surgery
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The occurrence of nausea and vomiting
Time Frame: Up to 7 days after surgery
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Incidence of nausea and vomiting
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Up to 7 days after surgery
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The occurrence of cardiovascular or cerebrovascular events
Time Frame: From the end of surgery to the time the patients discharge, up to 1 month.
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Incidence of cardiovascular or cerebrovascular adverse events
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From the end of surgery to the time the patients discharge, up to 1 month.
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Length of hospital stay
Time Frame: From the end of surgery to the time the patients discharge, up to 1 month.
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Length of hospital stay
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From the end of surgery to the time the patients discharge, up to 1 month.
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Mortality
Time Frame: 30-day after surgery
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Mortality after surgery
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30-day after surgery
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Mortality
Time Frame: 1-year after surgery
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Mortality after surgery
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1-year after surgery
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Concentration of norepinephrine
Time Frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of norepinephrine during surgery
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Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of epinephrine
Time Frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of epinephrine during surgery
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Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of cortisol
Time Frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of cortisol during surgery
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Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of tumor necrosis factor-α
Time Frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of tumor necrosis factor-α during surgery
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Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of interleukin-6
Time Frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Concentration of interleukin-6 during surgery
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Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Guanghong Xu, MD.PHD, The First Affiliated Hospital of Anhui Medical University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 15, 2020
Primary Completion (Actual)
July 30, 2021
Study Completion (Actual)
August 16, 2021
Study Registration Dates
First Submitted
February 29, 2020
First Submitted That Met QC Criteria
March 10, 2020
First Posted (Actual)
March 12, 2020
Study Record Updates
Last Update Posted (Actual)
August 24, 2021
Last Update Submitted That Met QC Criteria
August 22, 2021
Last Verified
March 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 201911
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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