- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05444777
The Effect of Low Dose Ketamine on Narcotic Consumption in Patients Undergoing Laparoscopic Cholecystectomy
Study Overview
Detailed Description
Pain management is an essential component of every surgical procedure due to its effect on early mobilization. Adequate pain relief leads to rapid recovery and improved surgical outcome. It also decreases the chances of deep vein thrombosis, neuropathic pain and cardio-respiratory complications resulting in decreased cost and length of stay in the hospital. Poorly managed pain is not only inhuman but also detrimental for the patient's overall condition.
Several narcotic and non-narcotic modalities have been used to achieve for adequate post-operative analgesia. Among these, opioid narcotics are widely used due to their potent analgesic effect. Unfortunately opioids have a number of unwanted side-effects including respiratory depression, chest rigidity, drowsiness, nausea and vomiting. These unwanted side-effects had been shown to be decreased by the use of low-dose ketamine used immediately before wound closure in a number of surgeries. It has been reported that single dose of 0.15-1 mg/kg ketamine along with opioids was effective in decreasing the post-operative narcotic consumption. Availability of narcotics is also an issue worldwide particularly in low income countries. Alternate drugs and methods have been tried to minimize opioid use. Low dose ketamine seems to be an effective adjunct in reducing opioid requirement during perioperative period. Subcutaneous and spray of low dose ketamine has also been tried successfully for tonsillectomy pain. The role of low dose ketamine in patients undergoing laparoscopic cholecystectomy is not clear and is yet to be studied in our population. To analyze this effect a randomized controlled trial was performed to study the effect of low-dose ketamine on the narcotic consumption in PACU after laparoscopic cholecystectomy.
Materials and Methods:
The Double Blind Randomized Controlled trial was carried out at the Department of Anaesthesia, Aga Khan University Hospital, after approval from the ethical review committee. Sample size was calculated to be 86 (43 in each arm receiving either ketamine or saline) using 80% power at 5% level of significance assuming a 30% difference in the mean narcotic consumption in the ketamine group as compared to the control group using NCSS~Pass (version, 11.04).
ASA I and II patients undergoing laparoscopic cholecystectomy between 25 to 60 years of age were randomly selected and informed consent was taken. Patients having psychological problems, seizures or any CNS disease, history of substance abuse, allergy to ketamine and pethidine, pregnancy, cardiovascular, hepatic or renal disease were excluded from the study.
Intraoperative analgesia was standardized in all patients by giving 3μgm/kg fentanyl at induction. Syringes containing 10 ml ketamine or normal saline were prepared and documented. Patients were randomly allocated by sealed envelopes into two groups. Group S was given placebo (saline) while group K was given ketamine 0.5mg/kg intravenously just after the wound closure.
Patient and the observer were blinded to the groups. Pain scores were documented in a proforma by using VAS as soon as patients were shifted to recovery room and repeated at 15 and 30 minutes interval. Pethidine 10 mg was administered intravenously as rescue analgesia whenever pain score was ≥ 4. Total pethidine consumption in initial 30 minutes of recovery stay was calculated and documented.
All patients were given supplemental oxygen in recovery room to prevent hypoxia. Tachycardia (heart rate ≥120bpm) and hypertension (SBP >140 mmHg) were managed by beta blockers.
All analyses were conducted using the Statistical Package for Social Science version 19 (SPSS Inc, Chicago, IL). Continuous data are presented as mean and standard deviation after normality testing by Kolmogorov-Smirnov and histogram and analyzed by independent sample t-test. Categorical data are presented as frequency and percentage and analyzed by Chi-square test or fisher exact test. Effect of the intervention on amount of pethidine consumption was assessed by general liner model and regression coefficient were reported. To assess whether the effect of the intervention differed over time, an interaction between time and intervention was tested. Effect of the intervention on pain (measured 5 times during the first postoperative day) was assessed using a generalized estimating equation with continuous time, exchangeable working correlation matrix structure. Main effects were time and intervention. Interaction between time and intervention was also tested. p≤0.05 was considered as significant.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- all ASA 1 and 2 patients undergoing Laparoscopic Cholecystectomy electively.
Exclusion Criteria:
- Hepatic and renal disease and ASA 3 and 4 patients.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ketamine group (Group K)
Group K was given ketamine @ 0.5mg/kg (prepared by dilution in 0.9% normal saline in 10 ml syringe) at the time of wound closure.
|
Ketamine was given prior to wound closure.
Other Names:
|
Other: Saline group (Group S)
Group S was given saline in 10 ml syringe
|
Ketamine was given prior to wound closure.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain score using Visual Analogue scale, ranging from 0 (minimum) and 10 (maximum), 3 and below showing no pain and scores above 3 showing moderate to severe pain.
Time Frame: Baseline on arrival in the post anaesthesia care unit and then every fifteen minutes unto one hour
|
Change in pain score using Visual Analogue Scale
|
Baseline on arrival in the post anaesthesia care unit and then every fifteen minutes unto one hour
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
narcotic consumption in the post operative anaesthesia care unit
Time Frame: postoperatively, after arrival in the post anaesthesia care unit at every fifteen minutes unto one hour
|
requirement of narcotic in the post anaesthesia care unit
|
postoperatively, after arrival in the post anaesthesia care unit at every fifteen minutes unto one hour
|
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
- Digestive System Diseases
- Pathological Conditions, Anatomical
- Gallbladder Diseases
- Biliary Tract Diseases
- Calculi
- Gallstones
- Cholelithiasis
- Cholecystolithiasis
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Dissociative
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Ketamine
Other Study ID Numbers
- 2387-Ane-ERC-12
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
product manufactured in and exported from the U.S.
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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