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Ideal Initial Bolus and Infusion Rate for Erector Spinae Plane Block Catheters

22. januar 2020 opdateret af: Virginia Commonwealth University
This study would like to identify the best starting dose and infusion rate for nerve blocks and nerve catheters related to the erector spinae plane block that can improve functional status and pain control on cardiac surgery patients and minimize the necessity for opioid pain control using a continuous reassessment model.

Studieoversigt

Status

Trukket tilbage

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

The study will continue taking steps in helping to identify the role erector spinae plane nerve blocks have in thoracic surgery. This is a relatively new nerve block (first identified and described in 2016) and the studies that have been done and the case series that have been reported have been very promising in supporting its role in thoracic surgery. As it is a plane block (not around a specific nerve but in a general area), larger volumes and doses often have to be used in these sorts of blocks (such as a transverses abdominalis plane block) to get good spread of the local anesthetic in the plane to reach the desired nerves that pass through this plane with one injection. Our hospital has been doing these blocks for patients as a standard of care for them, but this study will take a closer look to see if there is an optimal dose and volume of medicine to improve patients' functional status and pain control to minimize the need for opioids. The study will use a continuous reassessment model to determine the optimal dose.

Undersøgelsestype

Interventionel

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Virginia
      • Richmond, Virginia, Forenede Stater, 23298
        • Virginia Commonwealth University

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • patients undergoing planned thoracotomies and sternotomies for cardiothoracic surgery who will be taken to the cardiac surgery ICU postoperatively

Exclusion Criteria:

  • BMI >40
  • infection at the proposed catheter site
  • ongoing sepsis/bacteremia
  • patient unable to sit up for the procedure
  • patients requiring significant vasopressor support (>1 vasopressor)
  • patient refusal
  • less than 18 years of age (they are managed in the pediatric ICU rather than the Cardiac Surgery ICU)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Støttende pleje
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Bilateral catheters
patients receiving bilateral catheters (such as for patients undergoing sternotomies/midline incisions or with planned bilateral thoracotomy incisions)
Medicin: Ropivacaine 0.2%-Sodium Chloride 0.9% Injectable Solution bilaterally
Variable initial post-operative dose of 10cc to 40cc bilaterally with a variable programmed dose to be repeated afterward of 10cc to 40cc of 0.2% ropivacaine every 6 hours bilaterally.
Eksperimentel: Single catheter
patients who only have one catheter in place (such as in patients who have unilateral thoracotomies and not midline sternotomies)
Medicin: Ropivacaine 0.2%-Sodium Chloride 0.9% Injectable Solution unilaterally
Variable initial post-operative dose of 10cc to 40cc unilaterally with a variable programmed dose to be repeated afterward of 10cc to 40cc of 0.2% ropivacaine every 6 hours unilaterally.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Median Effective Dose
Tidsramme: 6.5 hours
Dose at which 50% of patients achieve a clinically significant nerve block after a single bolus and after periodic programmed boluses of Ropivacaine as represented by either an adequate decrease in sensation of the chest (covering at least 5 dermatomes) or an improvement in vital capacity breaths (of 500 mL or more)
6.5 hours

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in pain rating
Tidsramme: From just before to 30 minutes after a bolus is administered
Self reported pain rating on a 0-10 scale where 0 is no pain and 10 is pain as bad as it can be
From just before to 30 minutes after a bolus is administered
Change in heart rate
Tidsramme: From just before to 30 minutes after a bolus is administered
Heart rate measured using a heart rate monitor
From just before to 30 minutes after a bolus is administered
Blood pressure
Tidsramme: From just before to 30 minutes after a bolus is administered
Blood pressure measured using a blood pressure monitor
From just before to 30 minutes after a bolus is administered
Change in percent oxygen saturation of hemoglobin
Tidsramme: From just before to 30 minutes after a bolus is administered
Pulse oximetry reading from a monitor
From just before to 30 minutes after a bolus is administered
Changes in electrocardiogram tracing
Tidsramme: From just before a bolus is administered to 6.5 hours
Monitoring for changes in electrical conduction in the heart as monitored by the continuous 5 lead electrocardiogram tracing, watching for any side effects.
From just before a bolus is administered to 6.5 hours
Dermatomal coverage
Tidsramme: From just before to 30 minutes after a bolus is administered
The area of numbness experienced in the chest wall as measured using a pinprick test and documented on a cartoon map showing a chest wall and dermatomal borders
From just before to 30 minutes after a bolus is administered
Opioid consumption
Tidsramme: 6.5 hours
Total opioid medication consumption during the study period
6.5 hours
Non-narcotic pain medication consumption
Tidsramme: 6.5 hours
Total non-narcotic pain medicine consumption during the study period
6.5 hours

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Virginia Commonwealth University

Efterforskere

  • Ledende efterforsker: Bryant Tran, MD, Virginia Commonwealth University

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

23. juli 2019

Primær færdiggørelse (Forventet)

1. september 2020

Studieafslutning (Forventet)

1. september 2020

Datoer for studieregistrering

Først indsendt

21. maj 2019

Først indsendt, der opfyldte QC-kriterier

21. maj 2019

Først opslået (Faktiske)

23. maj 2019

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

27. januar 2020

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

22. januar 2020

Sidst verificeret

1. januar 2020

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • HM20014242

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

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