- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04917029
The Efficacy of Adding Dexmedetomidine Perineurally to Bupivacaine in Ultrasound Guided Fascia Iliaca Block Versus Intravenously Infused Dexmedetomidine on Hemodynamic Stability Intraoperatively and Postoperative Analgesia Following Hip Arthroscopy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study is a randomized controlled trial at Ain Shams university hospital, Cairo, Egypt. The study will include 88 patients (44 patients) in each group planned for undergoing hip arthroscopy under general anesthesia, will be randomly assigned into one of the following two groups using computer generated codes and opaque sealed envelopes:
All patients will range from ASA I or II, planned for elective hip arthroscopy, aging from 18 to 65 years, body weight renge from 70- 80 Kg of both sexes.
Patients will receive 0.03 mg/kg intravenous (IV) midazolam as a preanesthetic medication, and 1 mg Granisetron as a postoperative nausea and vomiting (PONV) prophylaxis after application of routine monitoring (electrocardiogram, non-invasive blood pressure monitoring and oxygen saturation (SPO2)).
A standard anaesthetic technique will be followed. After preoxygenation for three minutes, anaesthesia will be induced with: propofol 2-3 mg/kg, fentanyl 1µg/kg. Atracuirium besilate 0.5 mg/kg will be used to provide muscle relaxation. All patients will be mechanically ventilated with a tidal volume of 8 ml/kg. 1-2 minimum alveolar concentration (MAC) of isoflurane mixed with oxygen (50%) and air (50%) will be used for maintenance of anesthesia.
GROUP A will receive Dexmedetomidine in dose of of 0.5μg/ kg/hour It elicits a biphasic blood pressure response: a short hypertensive phase followed by hypotension. It is expected that the decreased blood pressure and heart rate, will happen with ongoing therapy within 15 minutes, mediated by central α2A-AR, that decrease the release of noradrenaline from the sympathetic nervous system (10) And that is the reason we will start Dexmedetomidine infusion just after intubation.
Then Ultrasound-guided block was performed in supine position, inguinal ligament was identified, and crease area was sterilized using povidone iodine. Using a 7.5 -12 MHz linear probe, started on the inguinal crease parallel to the inguinal ligament, and after identification of femoral artery, a little movement of the probe laterally till iliopsoas muscle was specified as a hypo echo part in lateral to the artery and femoral nerve. It is covered by a hyperechoic fascia, which separates the muscle from the subcutaneous tissue, using the in-plane technique a 22G/80 mm insulated echogenic block needle was inserted and advanced towards the fascia iliaca and iliopsoas muscle. Confirming the passage of the needle through the fascia iliaca using fascial click and 2mL of saline. LA was injected between fascia iliaca and iliopsoas muscle, we used ultrasound guided hydro dissection technique. Through this hydro dissection, the needle was moved towards the space created by the injected LA. The responsible anesthesiologist and the patient were unaware of the nature of drug in each syringe and master codes were stored by personnel who did not participate in observation.
Mean arterial blood pressure (MABP) and heart rate (HR) will be measured. Any increase or decrease in HR or blood pressure, will be managed as required after exclusion of a surgical cause. For example, MABP or HR rise of > 20% above baseline will be treated by administering a 0.5 μg/kg intravenous bolus of fentanyl.
MABP drop of > 20% below baseline will be dealt with reduction of the isoflurane concentration to 0.6%. If patient is still hypotensive, 6 mg ephedrine will be given intravenously. Finally, bradycardia will be treated with: 0.6 mg IV atropine bolus and repeated as required.
Fentanyl (0.5µg/kg IV) will be titrated intraoperatively at the discretion of the attending anaesthesiologists up to one hour prior to the end of surgery. No other intraoperative adjunct analgesic will be given.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Cairo, Egypt
- maha sadek El Derh
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients undergoing elective hip arthroscopy.
- ASA I and II patients
- aged 18 to 65 years,
- 70-80 kg,
both sexes.
- Exclusion Criteria:
- Refusal of the patient to receive FICB or to participate in the study,
- Impaired renal or hepatic functions,
- Asthmatic patients.
- Patients with multiple traumas.
- Obese patients with Body Mass Index > 35.
- Allergy to study drugs.
- Patients with local infection.
- Previous surgery at the injection area.
- Bleeding disorders.
- Patients on anticoagulant therapy,
- Addicts.
- Patients with an opioid analgesic prescription within the last 2 h before the operation.
- Peripheral neuropathy,
- Mental and or psychiatric disorders.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Active:Group A
Group A: receive 40 ml bupivacaine 0.25% +5 ml placebo in FICB perineurally in generally anaesthetized patients with intravenous infusion of 0.5 µg/kg/h of Dexmedetomidine.
|
Arm 1; Bupivacaine hydrochloride 40 ml 0.25% perineurally in FICB
Other Names:
Arm 1: infusion of Dexmedetmidine 0.5 µg/kg/h
Other Names:
|
Active Comparator: (Group B
Group B: receive FICB with dexmedetomidine 80µg diluted in 5 ml normal saline and 40 ml bupivacaine 0.25% added perineurally in generally anaesthetized patients without dexmedetomidine infusion.
|
Arm 1; Bupivacaine hydrochloride 40 ml 0.25% perineurally in FICB
Other Names:
Arm 2:Dexmedetomidine perineurally in FICB 80µg
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effect of dexmedetomidine infusion
Time Frame: introperative
|
incidence of need rescue agents (fentanyl) intraoperatively and the rate change in heart rate ang blood pressure
|
introperative
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual Analogue scale (VAS)
Time Frame: 24 hours postoperative
|
incidence of need of postoperative analgesic (pethidine) , time of first request and the total dose VAS Will be recorded at 2, 3, 4, 6, 8, 12, 18 and 24 hours.
Pethidine 20 mg was administered IV as rescue analgesic if VAS pain score was more than 3 or the patient asked for analgesia and can be repeated after 20 minutes till VAS≤3.
The time to first analgesic request and 24 hours total analgesic requirement were recorded and compared.
Also, fixed dose of 1 g intravenous acetaminophen will be given /8h.
|
24 hours postoperative
|
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
Additional Relevant MeSH Terms
- 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
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Anesthetics, Local
- Dexmedetomidine
- Bupivacaine
Other Study ID Numbers
- FMASU R 116/2021
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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