- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05241054
Effect of Local Anesthesia Versus Induced Hypotensive Anesthesia on Quality of External Dacryocystorhinostomy Operation
Comparison of Local Anesthesia and Induced Hypotensive Anesthesia on Quality of External Dacryocystorhinostomy Operation Under General Anesthesia
Study Overview
Status
Detailed Description
Dacryocystorhinostomy or DCR is among the common oculoplastics surgeries performed for managing epiphora due to nasolacrimal duct obstruction. The main purpose of DCR surgery is to eliminate the obstruction and to accomplish normal tear. DCR is a procedure performed to drain the lacrimal sac in which lacrimal flow is diverted into the nasal cavity through an artificial opening made at the level of the lacrimal sac in cases of chronic dacryocystitis or symptomatic nasolacrimal duct obstruction not relieved by simple probing and stringing.
Dacryocystorhinostomy (DCR) operation can be performed externally or endoscopically. External DCR was first described by Toti and this procedure was modified with the use of flaps by many authors. It is the gold standard of treatment with a reported success rate of more than 90%.
Bleeding during dacryocystorhinostomy (DCR) is trivial, but because of the anatomical vessel variation and presence of tiny vessels in the field of DCR, it can obscure the surgical field and complicate the operation.
One of the effective approaches for controlling bleeding tendency during DCR is to reduce blood pressure in patients. Ideal hypotensive medications administered to reduce blood pressure should have specific features such as easy to administration, being with rapid onset and offset without side effects, rapid elimination without any toxic metabolites, and having a predictable and dose-dependent action. Nitroglycerine (TNG) is a direct vasodilator agent, especially in veins, and produces hypotension, and is preferred by clinicians because of rapid onset and offset time and easy titration.
Another mechanism for controlling bleeding is infiltrating the incision site by local anesthetic with admixed epinephrine to promote local vasoconstriction to decrease blood loss and prolong the duration of local anesthesia providing more time for analgesia.
In this study, the investigators will compare the efficacy of local versus induced hypotensive anesthesia in generally anesthetized patients undergoing external DCR operation on amount of blood loss, quality of the surgical field, intraoperative hemodynamics, and surgeon satisfaction
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ola T Abdel Dayem, MD
- Phone Number: 00201202811110
- Email: olataha2007@yahoo.com
Study Contact Backup
- Name: Hazem Moawad, MD
- Phone Number: 00201121516041
- Email: hazemmoawad@yahoo.com
Study Locations
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DK
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Mansoura, DK, Egypt, 050
- Mansoura University
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Contact:
- Ola T Abdel Dayem, MD
- Phone Number: 00201202811110
- Email: olataha2007@yahoo.com
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Contact:
- Hazem Moawad, MD
- Phone Number: 00201121516041
- Email: hazemmoawad@yahoo.com
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Principal Investigator:
- Mohamed M Tawfik, MD
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Sub-Investigator:
- Ola S Elnagar, M.Sec
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- American Society of Anesthesiologists physical status I and II
- patients who are scheduled for external Dacryocystorhinostomy operation
Exclusion Criteria:
- Patient refusal.
- Patients with history for cerebrovascular.
- Patients with history for coronary insufficiency.
- Local skin infection at site of injection.
- Known hypersensitivity to the study drugs.
- Extremes of age.
- Patients with any type of arrhythmias.
- Hematological diseases.
- Bleeding abnormality
- Coagulation abnormality
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Bupivacaine
Patients will receive local anesthesia by paranasal infiltration at the incision site with 2.5 ml of 0.5% bupivacaine with 1:100000 epinephrine.
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With patient in supine position, the patient will be placed on the operating table with a head-up tilt to reduce venous congestion at the operative site.
Skin will be disinfected, the patient will receive local anesthesia by paranasal infiltration at the incision site with 2.5 ml of 0.5% bupivacaine with 1:100000 epinephrine.
General anesthesia will be induced using IV propofol at dose of 1-2 mg.kg
fentanyl 1 microgram.kg
Atracurium besylate 0.5mg.kg to facilitate intubation followed will top up dose of atracurium(0.1mg/kg).
Patient will then be mechanically ventilated using a volume control mode with tidal volume 6-8ml/kg, respiratory rate 10-14 breath/min and I.E ratio1:2 to maintain end tidal CO2 around 35 mmHg
Anesthesia will then be maintained using sevoflurane 2%, and 60% air in oxygen mixture and top up dose of
Intravenous infusion of Lactated Ringers will be given per body weight and according to intraoperative loss
The patient is placed on the operating table with a head-up tilt to reduce venous congestion at the operative site
paracetamol infusion (15 mg/kg) will be given by IV infusion in both groups
|
Active Comparator: Nitroglycerine
Patients will receive an infusion of Nitroglycerine (TNG) (0.2-1μg/kg/min) will be started and adjusted to maintain mean arterial blood pressure between 55-65 mmHg.
|
General anesthesia will be induced using IV propofol at dose of 1-2 mg.kg
fentanyl 1 microgram.kg
Atracurium besylate 0.5mg.kg to facilitate intubation followed will top up dose of atracurium(0.1mg/kg).
Patient will then be mechanically ventilated using a volume control mode with tidal volume 6-8ml/kg, respiratory rate 10-14 breath/min and I.E ratio1:2 to maintain end tidal CO2 around 35 mmHg
Anesthesia will then be maintained using sevoflurane 2%, and 60% air in oxygen mixture and top up dose of
Intravenous infusion of Lactated Ringers will be given per body weight and according to intraoperative loss
The patient is placed on the operating table with a head-up tilt to reduce venous congestion at the operative site
paracetamol infusion (15 mg/kg) will be given by IV infusion in both groups
This group includes 32 patients (anticipated), infusion of Nitroglycerine (TNG) (0.2-1µg/kg/min) will be started and adjusted to maintain mean arterial blood pressure between 55-65mmHg.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average category scale (ACS)
Time Frame: after 10 min of maintaining mean arterial blood pressure (MAP) at the desired range (55-65 mmHg)
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Assessment of intraoperative blood loss and quality of surgical field by Average category scale (ACS) for assessment of intraoperative surgical field (0-5): 0 - No bleeding 1 - Slight bleeding - no suctioning of blood required 2 - Slight bleeding 3- slight bleeding required suctioning 4- moderate bleeding 5- sever bleeding
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after 10 min of maintaining mean arterial blood pressure (MAP) at the desired range (55-65 mmHg)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean arterial blood pressure
Time Frame: procedure (basal reading and every 5 minutes till the end of anesthesia )
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Mean arterial blood pressure values will be recorded
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procedure (basal reading and every 5 minutes till the end of anesthesia )
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Heart Rate (HR)
Time Frame: procedure (basal reading and every 5 minutes till the end of anesthesia)
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Heart Rat values will be recorded
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procedure (basal reading and every 5 minutes till the end of anesthesia)
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Postoperative visual analogue score (VAS)
Time Frame: up to 24 hours after the procedure
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Pain levels will be assessed post operatively using visual analogue score (vas) at 0 min , 6 hour, 12hour , 24hours postoperatively .
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up to 24 hours after the procedure
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Postoperative analgesics intake
Time Frame: up to 24 hours after the procedure
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Total dose of ketorolac requirements will be recorded
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up to 24 hours after the procedure
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Surgeon satisfaction
Time Frame: at the end of the procedure
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Surgeon satisfaction will be recorded based on a 4 points scale (1=bad, 2=moderate, 3=good, 4=excellent).
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at the end of the procedure
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Nausea
Time Frame: up to 24 hours after the procedure
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Postoperative Nausea will be assessed on a scale of 0 to 3 [0; no nausea, 1, mild nausea, 2; moderate nausea, 3; severa nausea]
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up to 24 hours after the procedure
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Vomiting
Time Frame: up to 24 hours after the procedure
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Postoperative Vomiting will be assessed on a scale of 0 to 3 [0; no vomiting, 1, mild vomiting, 2; moderate vomiting, 3; severe vomiting]
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up to 24 hours after the procedure
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Hematoma
Time Frame: up to 24 hours after the procedure
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The patients will be evaluated postoperatively to identify the occurrence of hematoma (blood collection, swelling, bruises) at the site of injection of bupivacaine.
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up to 24 hours after the procedure
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Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Ola T Abdel Dayem, MD, professor, MD anesthesia Department, Faculty of Medicine, Mansoura University, Egypt
- Study Director: Hazem Moawad, MD, Assistant professor, MD anesthesia Department, Faculty of Medicine, Mansoura University, Egypt
Study record dates
Study Major Dates
Study Start (Anticipated)
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
Additional Relevant MeSH Terms
- Eye Diseases
- Lacrimal Apparatus Diseases
- Lacrimal Duct Obstruction
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Vasodilator Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Cholinergic Antagonists
- Cholinergic Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Analgesics, Non-Narcotic
- Platelet Aggregation Inhibitors
- Antipyretics
- Analgesics, Opioid
- Narcotics
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anesthetics, Local
- Anesthetics, Inhalation
- Neuromuscular Agents
- Nicotinic Antagonists
- Neuromuscular Nondepolarizing Agents
- Neuromuscular Blocking Agents
- Fentanyl
- Propofol
- Acetaminophen
- Sevoflurane
- Bupivacaine
- Nitroglycerin
- Atracurium
Other Study ID Numbers
- MD / 21.09.536
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
- Clinical Study Report (CSR)
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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