- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04375826
Preperitoneal Analgesia Versus Epidural Analgesia After Open Pancreaticoduodenectomy (Pain)
Continuous Preperitoneal Analgesia Versus Thoracic Epidural Analgesia After Open Pancreaticoduodenectomy: A Randomized Controlled Open-labeled Noninferiority Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In the Enhanced recovery after surgery (ERAS) program of pancreaticoduodenectomy (PD), thoracic epidural analgesia (or epidural analgesia) was considered to be a key analgesic method because it not only effectively controls pain, but also lowers insulin resistance and helps restore bowel movement. However, epidural analgesia can cause a number of side effects despite of effective pain control. Epidural analgesia reduces peripheral vascular resistance by blocking sympathetic nerves with local anesthetics and may cause hypotension and decreasing heart rate. In addition, it can cause orthostatic hypotension, which can interfere with early ambulation after operation. In rare cases, there are potential complications of epidural abscess, meningitis, and epidural hematoma.
Continuous peritoneal analgesia using local anesthetics has recently been used as an alternative analgesic to epidural analgesia in open abdomen surgery. This is easier to perform than epidural analgesia and is known to have fewer side effects. Recently, a non-inferiority comparison study have revealed that peritoneal analgesic was not inferior to epidural analgesia in terms of pain control. However, this study included a variety of operations other than PD, and most of the incisions were substernal, not midline. In addition, the method for mounting the epidural catheter was not described. The failure rate of the epidural catheter was reported to be 15%.
The investigators will examine the effect of continuous peritoneal analgesic postoperative pain control in patients undergoing open PD to improve postoperative pain management and to create an our own ERAS program. To this end, The investigators will test non-inferiority between epidural analgesia and peritoneal analgesia.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jin-Young Jang, M.D., PhD.
- Phone Number: 82-2-2072-2194
- Email: jangjy4@snu.ac.kr
Study Contact Backup
- Name: Yoo Jin Choi, M.D.
- Phone Number: 82-2-2072-1959
- Email: ujinny30@gmail.com
Study Locations
-
-
-
Seoul, Korea, Republic of, 110-744
- Recruiting
- Department of Surgery, Seoul National University College of Medicine
-
Contact:
- Jin- Young Jang, M.D., PhD.
- Phone Number: 82-2-2072-2194
- Email: jangjy4@gmail.com
-
Contact:
- Wooil Kwon, M.D., PhD.
- Phone Number: 82-2-2072-2817
- Email: willdoc78@gmail.com
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Principal Investigator:
- Jin- Young Jang, M.D., PhD.
-
Sub-Investigator:
- Wooil Kwon, M.D., PhD.
-
Sub-Investigator:
- Hongbeom Kim, M.D.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18 years and older
- Disease of periampullary lesions
- Elective open pancreaticoduodenectomy (PD): PD or pylorus preserving pancreaticoduodenectomy (PPPD)
- Midline incision
- Written informed consent : ability to understand and the willingness to sign a written informed consent
- Performance status (ECOG scale): 0-1 at the time of enrollment
- Physical status (ASA) : 1-2 grade
Exclusion Criteria:
- History of any abdominal surgery (except laparoscopic appendectomy, laparoscopic/robotic cholecystectomy, laparoscopic/robotic obstetrics and gynecology surgeries,Cesarean section, laparoscopic/robotic prostate surgery)
- Emergency operation
- History of chronic pain
- Chronic use of opioid, analgesics, anti-depressant, anti-epileptics (>1year)
- Alcoholics
- Impossible to control PCA d/t delirium, cognitive impairment
- Contraindication for epidural analgesia
- Patients with coagulopathy (INR>1.5, Prothrombin time>1.5, platelets <80x10^9perL) or anti-coagulants
- Hypersensitive to fentanyl and ropivacaine
- Need other organ resection (ex. Liver, colon)
- Intubation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Epidural analgesia
Only Epidural analgesia is used for this group
|
The device is connected to the epidural catheter prior to surgery and drug administration is started during surgery.
The continuous infusion rate is 4 ml / hr.
When the button is pressed, 2 ml is additionally administered and the lock time is 20 minutes.
|
Active Comparator: Preperitoneal analgesia and IV-PCA
This group is given with both preperitoneal analgesia and Intravenous Patient Controlled Analgesia (IV-PCA)
|
During surgery, the preperitoneal analgesia catheters are inserted into the preperitoneal space and these catheters are connected to the pump with ropivacaine.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Numerical rating score for pain at 24 hours after operation
Time Frame: 24 hours after operation
|
The scale of the numerical rating score for pain is 0~10 and higher score is worse outcome. At 24 hours after operation, NRS pain scores are compared between two groups. |
24 hours after operation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain related factors
Time Frame: postoperative day 1,2,and 3
|
The scale of the numerical rating score for pain is 0~10 and higher score is worse outcome. Numerical rating score for pain on postoperative day 2 and 3 at 4pm |
postoperative day 1,2,and 3
|
Overall benefit of analgesia score (OBAS)
Time Frame: postoperative day 1,2,and 3
|
OBAS on postoperative day 1,2,and 3.
This include 7 questions.
To calculate the OBAS score, compute the sume of scores in items 1~6 and add "4-socore in item 7".
The minimum score is 4 and the maximum is 24.The low score indicates high benefit.
|
postoperative day 1,2,and 3
|
Recovery related factors
Time Frame: Within 1 week after operation
|
Time to first eat meal, time to first move, time to first gas out
|
Within 1 week after operation
|
Postoperative complication factors
Time Frame: Within 1 week after operation
|
Clavien-Dindo classification, postoperative pancreatic fistula
|
Within 1 week after operation
|
analgesic related factors
Time Frame: Within 2 week after operation
|
rescue analgesics amounts, opioid amounts
|
Within 2 week after operation
|
Collaborators and Investigators
Investigators
- Study Chair: Jin-Young Jang, M.D., PhD., Seoul National University Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Other Study ID Numbers
- 2003-128-111
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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