- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04587505
Effect of Epidural Anesthesia and Analgesia on Quality of Recovery After Radical Prostatectomy. (QoR)
September 28, 2021 updated by: Ruben Kovac, University Hospital of Split
Is Postoperative Quality of Recovery After Radical Prostatectomy Related to the Type of Anesthesia and Analgesia?
Postoperative quality of recovery (QoR) could be related to anesthesia and postoperative analgesia.
This study is exploring early QoR after radical prostatectomy in the two groups of anesthesia.
The first group had a light general anesthesia with lumbal epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine.
The second group had general anesthesia and a continuous postoperative analgesia with tramadol.
The postoperative QoR was evaluated 24 hours after surgery.
Study Overview
Status
Completed
Conditions
Detailed Description
All participants were premedicated with diazepam 5 mg 12 hours and 1 hour before surgery.
Thromboprophylaxis ( 4,000 - 6000 IU) depending on the body weight was given at least 12 hours before surgery.
All participants were warmed to prevent unintended hypothermia.
Participants were allocated by permuted block randomisation into one of two groups: general anesthesia group and epidural anesthesia.
The randomisation list was obtained from R program version 3.5.3.
The group allocations were contained in a closed envelope that were opened before surgery after the completed enrollment procedure.
All patients and infusions were wormed to prevent unintended hypothermia.
Induction of general anesthesia was with midazolam 2.5 mg, fentanyl 100 μg, propofol 1-2 mg/kg and vecuronium 0.1 mg/kg.
Balanced crystalloid fluids were used to treat hypovolemia.
Additionally, 6% Hydroxyethyl starch was used before blood transfusion products to treat profound hypovolemia.
Blood transfusions were given according to blood loss and clinical situation.
Bradycardia was treated with atropine.
Hypotension was treated with ephedrine boluses.
Anti-inflammatory drug metamizole (dipyrone) 2.5 g was given intravenously before the end of the surgery and after 12 hours after the surgery.
Neostigmine 2.5 mg with atropine 1 mg was used for the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery.
Participants were placed for one day in a urology high care unit provided with constant and vigilant nurse care.
Crystalloid infusions were used for maintaining diuresis.
Gastroprotection was done with pantoprazole 40 mg.
Metoclopramid 10 mg was given for postoperative nausea and vomiting (PONV).
The postoperative QoR was evaluated with three QoR scales.
Scales for pain, anxiety and PONV were also examined.
The 36-Item Short Form Survey (SF-36) questionnaire evaluated quality of life one month before and one month after surgery.
Study Type
Interventional
Enrollment (Actual)
61
Phase
- Phase 4
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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Split, Croatia, 21000
- University Hospital Split
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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 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Male
Description
Inclusion Criteria:
- Elective radical Prostatectomy.
- American Society of Anesthesiologists (ASA) physical status classification system: I, II, III
Exclusion Criteria:
Dementia
- Delirium
- Acute psychosis
- Emergent surgery
- Hospitalisation in Intensive care unit
- American Society of Anesthesiologists (ASA) physical status classification system: IV
- Reoperations
- Muscular diseases
- Montreal cognitive test <24 points
- Contraindications for epidural anesthesia
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: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Epidural anesthesia and analgesia
Epidural catheter insertion: Th 12- L 1 or Th 11 - Th 12 using the midline approach.
Safety of the epidural catheter was confirmed with lidocaine 60 mg.
Epidural loading dose was given according to our classification (3,4,5 or 6 ml).
Postoperative period in urology high care unit.
Epidural analgesia ropivacaine/morphine was administered by a urologist according to our classification (2x2 ml, 2x3 ml and 3x3 ml).
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Epidural anaesthesia: mixture of ropivacaine 6.5 mg/ ml and fentanyl 8.3 μg/ml.
Light general anesthesia: isoflurane in mixture of 50/50 of nitrous oxide and oxygen to achieve Minimum alveolar concentration between 0.6 and 0.8.
Before the end of operation was given 4 ml of the mixture of ropivacaine 4.4 mg/ml and morphine 0.8mg/ ml.
Epidural analgesia was continued for next 24 hours with a mixture of ropivacaine 2.2 mg/ml and morphine 0.4 mg/ml.
Other Names:
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Active Comparator: Balanced general anesthesia and tramadol analgesia
Postoperative period in urology high care unit.
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Maintaining general anesthesia: nitrous oxide and oxygen in mixture 50/50 and isoflurane to achieve minimum alveolar concentration between 0.8 and 1. Fentanyl loading dose: 6-8 μg/kg.
Additional fentanyl doses were given incrementally.
Tramadol 100 mg in the first hour followed by tramadol 300 mg continuously for the next 24 hours.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual analog scale of quality of recovery (QoR)
Time Frame: 24 hours after surgery
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Patient rated visual analog scale is a simple scale for rating the quality of recovery by placing "X" on the line.
The scale is 100 millimetres long.
Poor recovery is on the left side of the line.
Under the end of the left line is an explanation of poor recovery: in severe pain,nausea & vomiting, confused, immobilized, unable to eat and unable to communicate.
Excellent recovery is on the right side of the line.
Under the end of the line is a written explanation: without any pain, comfortable, alert, active, enjoying food and communicating freely.
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24 hours after surgery
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Quality of recovery 40 (QoR-40)
Time Frame: 24 hours after surgery
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The QoR-40 measures five related dimensions of quality of recovery: emotional state (8 items), physical comfort (12 items), physical independence (5 items), psychological support (7 items) and pain (7 items).
Each item is rated on a 5 point Likert scale.
Minimal possible score is 40 and maximal possible score is 200.
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24 hours after surgery
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Quality of recovery 15 (QoR-15)
Time Frame: 24 hours after surgery
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Quality of recovery (QoR-15) is a short version of QoR - 40 questionnaire.
The QoR-15 questionnaire has 15 items scaled from 0 to 10. Minimum score is 0, and maximum 150.
It is shorter, user friendly and less time consuming then extensive QoR-40 questionnaire.
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24 hours after surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual analog scale of pain- at rest and during coughing and straining
Time Frame: 24 hours after surgery
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Patient rated visual analog pain scale is a simple scale for rating the pain intensity by placing "X" on the line.
The scale is 100 millimetres long.
No pain at all is written on the left side of the line and will correspond to 0 millimetres.
The worst possible pain is on the right side of the line.
The worst possible pain will correspond to 100 millimetres.
It is important to asses pain intensity at rest and pain intensity during activity (coughing, straining or getting up from bed ).
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24 hours after surgery
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Numerical pain scale - at rest and during coughing and straining
Time Frame: 24 hours after surgery
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Similar to the visual analog scale of pain, but instead of line, it consists of a sequence of numbers (0-10).
For some participants, scaling pain in numbers (0-10) is more clear than analog scale.
No pain will at all will correspond to 0 and the worst possible pain will correspond to 10.
It is important to asses pain intensity at rest and pain intensity during activity (coughing, straining or getting up from bed ).
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24 hours after surgery
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Visual pain scale with faces- at rest and during coughing and straining
Time Frame: 24 hours after surgery
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Similar to the numeric pain scale.
If pain scaling in numbers is vaguely, then six faces with emotional expression ranging from a happy smiling to a crying face with tears explain numbers under the faces (0,2,4,6,8,10).
It was designated for children.
No pain will at all will correspond to 0 and the worst possible pain will correspond to 10.
It is important to asses pain intensity at rest and pain intensity during activity (coughing, straining or getting up from bed ).
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24 hours after surgery
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Visual analog scale of anxiety
Time Frame: 24 hours after surgery
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Patient rated visual analog scale is a simple scale for rating the level of anxiety by placing "X" on the line.
The scale is 100 millimetres long.
No anxiety at all is written on the left side of the line.
No anxiety at all will correspond to 0 millimetres.
The worst possible anxiety is on the right side of the line.The worst possible pain will correspond to 100 millimetres.
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24 hours after surgery
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Numerical anxiety scale
Time Frame: 24 hours after surgery
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Similar to the visual analog scale of anxiety, but instead of line, it consists of a sequence of numbers (0-10).
For some participants, scaling in numbers (0-10) is more clear than analog scale.
No anxiety at all will correspond to 0 and the worst possible anxiety will correspond to 10.
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24 hours after surgery
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Visual anxiety scale with faces
Time Frame: 24 hours after surgery
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Similar to the numerical anxiety scale.
For some patients quantifying pain in numbers is vague, but if they can observe faces with different emotional expressions ranging from a happy smiling to a crying face with tears.
Under the faces are written corresponding numbers (0,2,4,6,8,10).
No anxiety at all will correspond to 0 and the worst possible anxiety will correspond to 10.
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24 hours after surgery
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The short form health survey version one (SF-36:I)
Time Frame: 24 hours after surgery and one month after surgery]
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The short form health survey version one (SF-36:I.)
measure eight dimensions of quality of life: physical functioning (10 items), role limitation due to physical problems (4 items), bodily pain (2 items), social functioning (2 items), mental health (5 items), role limitation due to emotional problems (3 items), vitality (4 items) and general health perception (5 items).
Each dimension has a possible score of 0 (poor health) to 100 (excellent health).
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24 hours after surgery and one month after surgery]
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Simplified postoperative nausea and vomiting (PONV) impact scale
Time Frame: 24 hours after surgery
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PONV impact scale consists of 2 questions that are scored from 0 to 3. Five points or six defines clinically important PONV.
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24 hours after surgery
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Global visual analog and numeric scale of nausea intensity
Time Frame: 24 hours after surgery
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Scale for rating the nausea intensity by placing "X" on the line.
No nausea at all is written on the left side of the line.
The worst possible nausea experienced is on the right side of the line.
Under the line are written numbers (0-10).
No nausea at all will correspond to 0 and the worst possible nausea will correspond to 10.
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24 hours after surgery
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Ruben Kovac, University Hospital Split, Department of Anesthesiology and Intensive Care, Split, Croatia
- Study Chair: Bozidar Duplancic, University Hospital Center Split, Department of Anesthesiology and Intensive Care, Split, Croatia
- Study Chair: Ivan Velat, University Hospital Center Split, Department of Urology, Split, Croatia
- Study Chair: Hrvoje Vucemilovic, University Hospital Center Split, Department of Anesthesiology and Intensive Care, Split, Croatia
- Study Chair: Svjetlana Dosenovic, University Hospital Center Split, Department of Anesthesiology and Intensive Care, Split, Croatia
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013 Jun;118(6):1332-40. doi: 10.1097/ALN.0b013e318289b84b.
- Kleif J, Waage J, Christensen KB, Gogenur I. Systematic review of the QoR-15 score, a patient- reported outcome measure measuring quality of recovery after surgery and anaesthesia. Br J Anaesth. 2018 Jan;120(1):28-36. doi: 10.1016/j.bja.2017.11.013. Epub 2017 Nov 22.
- Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000 Jan;84(1):11-5. doi: 10.1093/oxfordjournals.bja.a013366.
- Greg Snow (2020) blockrand: Randomization for Block Random Clinical Trials. R package version 1.5. https://CRAN.R-project.org/package=blockrand
- Stamer UM, Hothker F, Lehnen K, Stuber F. [Postoperative analgesia with tramadol and metamizol. Continual infusion versus patient controlled analgesia]. Anaesthesist. 2003 Jan;52(1):33-41. doi: 10.1007/s00101-002-0427-1. German.
- Myles PS. Measuring quality of recovery in perioperative clinical trials. Curr Opin Anaesthesiol. 2018 Aug;31(4):396-401. doi: 10.1097/ACO.0000000000000612.
- Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, Bost JE, Kluivers KB, Nilsson UG, Tanaka Y, Forbes A. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013 Aug;111(2):161-9. doi: 10.1093/bja/aet014. Epub 2013 Mar 6.
- Kleif J, Gogenur I. Severity classification of the quality of recovery-15 score-An observational study. J Surg Res. 2018 May;225:101-107. doi: 10.1016/j.jss.2017.12.040. Epub 2018 Feb 21.
- Cao X, Yumul R, Elvir Lazo OL, Friedman J, Durra O, Zhang X, White PF. A novel visual facial anxiety scale for assessing preoperative anxiety. PLoS One. 2017 Feb 14;12(2):e0171233. doi: 10.1371/journal.pone.0171233. eCollection 2017.
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)
April 1, 2019
Primary Completion (Actual)
April 1, 2021
Study Completion (Actual)
June 1, 2021
Study Registration Dates
First Submitted
October 7, 2020
First Submitted That Met QC Criteria
October 7, 2020
First Posted (Actual)
October 14, 2020
Study Record Updates
Last Update Posted (Actual)
September 30, 2021
Last Update Submitted That Met QC Criteria
September 28, 2021
Last Verified
September 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2181-147-01/06/M.S.-19-2/16
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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