Aprepitant to Improve Same Day Discharge for TKA
Preoperative Aprepitant to Improve Same-Day Discharge After Total Knee Arthroplasty: A Randomized Double-Blind Placebo-Controlled Trial
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Ilmoittautuminen
Vaihe
Vaihe
- Vaihe 4
Yhteystiedot ja paikat
Opiskeluyhteys
Opiskeluyhteys
- Nimi: Jessica Brickner
- Puhelinnumero: 847-570-1197
- Sähköposti: jessica.brickner@endeavorhealth.org
Tutki yhteystietojen varmuuskopiointi
- Nimi: Nia Moragne
- Puhelinnumero: 084-570-1197
- Sähköposti: nia.moragne@endeavorhealth.org
Opiskelupaikat
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Illinois
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Skokie, Illinois, Yhdysvallat, 60076
- Endeavor Health Skokie Hospital
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Ottaa yhteyttä:
- Jessica Brickner
- Puhelinnumero: 847-570-1197
- Sähköposti: jessica.brickner@endeavorhealth.org
-
Ottaa yhteyttä:
- Nia Moragne
- Puhelinnumero: 847-570-1197
- Sähköposti: nia.moragne@endeavorhealth.org
-
Päätutkija:
- Steven Greenberg, MD
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Receiving primary, unilateral elective TKA with or without abductor canal block
- Asa I-III
- Age 18-90
- Ability to receive ondansetron and dexamethasone
- Ability to consent and complete surveys
- English or Spanish speaking
- Receiving regional anesthesia (epidural or spinal) for surgery
Exclusion Criteria:
- Allergy to any of the anti-emetics being administered
- Current treatment of pimozide
- Emergent surgery
- Revision/ multiple revisions of TKA
- Clinical suspicion of possible bowel obstruction
- Need for general anesthesia
- Pregnant/breast feeding
- AST> 2.5 x the upper limit of normal or ALT> 2.5 x upper limit of normal, bilirubin> 1.5x upper limit of normal
- Need for opioid or benzodiazepine antagonists
- Not planned for same day discharge
- Enrollment in a different drug trial for TKA
- Unable to consent in English or Spanish
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Ennaltaehkäisy
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Kolminkertaistaa
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
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Kokeellinen: aprepitant
Single intravenous (IV) bolus of 32mg aprepitant preoperatively , in addition to the standard antiemetic protocol (4 mg IV dexamethasone after induction of MAC sedation anesthesia and 4 mg IV ondansetron at surgical closure)
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32mg aprepitant will be administered intravenously preoperatively during single sided total knee arthroscopy
4 mg IV ondansetron will be given at surgical closure during total knee arthroscopy
4 mg IV dexamethasone will be given after induction of MAC sedation anesthesia during total knee arthroscopy
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Placebo Comparator: Placebo
Single intravenous (IV) bolus of 32mg of placebo preoperatively, in addition to the standard antiemetic protocol (4 mg IV dexamethasone after induction of MAC sedation anesthesia and 4 mg IV ondansetron at surgical closure)
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4 mg IV ondansetron will be given at surgical closure during total knee arthroscopy
4 mg IV dexamethasone will be given after induction of MAC sedation anesthesia during total knee arthroscopy
Patients will receive 32 mg of intravenous (IV) placebo preoperatively for a total knee arthroscopy
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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difference in the incidence of same-day discharges between two randomized groups of anti-emetic regimens for anesthesia care
Aikaikkuna: patients will be followed from arrival for surgery to 7 days post operatively
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difference in the incidence of same-day discharges between two randomized groups of anti-emetic regimens for anesthesia care.
Subjects will be randomized to either the aprepitant group (administration of aprepitant, ondansetron, and dexamethasone) or control (ondansetron, dexamethasone, and placebo).
PACU and ASU staff will collect real time data with regard to the primary and secondary reason for any hospital admission (PONV, Pain control, Rapid response team called, Vital sign abnormalities, Change in mental status, Other).
Same day discharge will be defined by patients who are discharged from the hospital before 12 A.M day of surgery.
We will use the validated simplified PONV Impact Scale that uses patient assessment of nausea and vomiting to identify clinically important PONV upon PACU and ASU discharge (a PONV impact scale score of greater than or equal to 5 defines clinically important PONV).
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patients will be followed from arrival for surgery to 7 days post operatively
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Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Rescue antiemetics
Aikaikkuna: From date of admission to perioperative procedural area until hospital discharge or up to 30 days whichever is first
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Compare rescue antiemetics doses and counts given during the hospital stay in each group.
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From date of admission to perioperative procedural area until hospital discharge or up to 30 days whichever is first
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Incidence of vomiting
Aikaikkuna: Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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Compare the incidence of vomiting between both groups in PACU and ASU (None = No PONV symptoms, Mild = Patient feels queasy but is able to take PO, will treat with alcohol pads and/or QueaseEASE, Moderate = Patient is unable to take PO and is restless, will treat with rescue antiemetics per standard PACU orderset, Severe = Actively vomiting, will treat with rescue antiemetics per standard PACU orderset)
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Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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patients with no PONV
Aikaikkuna: arrival at hospital to post op day 7
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Compare the number of patients in each group who experience no PONV.
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arrival at hospital to post op day 7
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Compare the incidence of PONV in PACU and ASU
Aikaikkuna: Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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Compare the incidence of PONV between both groups in PACU and ASU using Endeavor Health SKH PACU PONV assessment scales, and stratify both groups by none, mild, moderate, and severe PONV (None = No PONV symptoms, Mild = Patient feels queasy but is able to take PO, will treat with alcohol pads and/or QueaseEASE, Moderate = Patient is unable to take PO and is restless, will treat with rescue antiemetics per standard PACU orderset, Severe = Actively vomiting, will treat with rescue antiemetics per standard PACU orderset)
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Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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Clinically important PONV
Aikaikkuna: Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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Compare the incidence of clinically important PONV between both groups in PACU and ASU using the validated simplified PONV Impact Scale.
a PONV impact scale score of greater than or equal to 5 defines clinically important PONV
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Upon post-anesthesia care unit (PACU) arrival (within ~2-3 hours after procedure), upon PACU discharge (~4-5 hours after procedure/medically cleared to leave PACU), admission to ASU directly after medically cleared from PACU to discharge from ASU
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Readmission rates
Aikaikkuna: Discharge of hospital to 7 days post operatively
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Compare readmission rates within 7 days postoperatively, stratified by admissions due to nausea/vomiting or related complications, and those for other medical or surgical reasons.
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Discharge of hospital to 7 days post operatively
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Postoperative Delirium Measured by 4AT Assessment
Aikaikkuna: Preoperative baseline and upon PACU discharge (~4 hours after procedure/medically cleared to leave PACU).
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Compare incidence of delirium in both groups.
Delirium will be detected using the 4AT validated survey upon PACU discharge compared to a preoperative baseline assessment Preoperative baseline
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Preoperative baseline and upon PACU discharge (~4 hours after procedure/medically cleared to leave PACU).
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Compare APFEL Score
Aikaikkuna: Preoperatively in Holding area
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Compare Apfel Scores for Postoperative Nausea and Vomiting in both groups (determined preoperatively in holding area by research team) .
Apfel score is a quick, validated clinical tool used by anesthesiologists to predict a patient's risk of developing Postoperative Nausea and Vomiting (PONV).The total score (0-4) predicts the percentage risk of developing PONV
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Preoperatively in Holding area
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Compare length of stays between groups
Aikaikkuna: From date of procedure through hospital discharge (up to 30 days after procedure date, whichever comes first)
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Compare PACU length of stay (hours) and hospital length of stay (hours) between groups.
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From date of procedure through hospital discharge (up to 30 days after procedure date, whichever comes first)
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opioid consumption
Aikaikkuna: From date of procedure through hospital discharge (up to 30 days after procedure date, whichever comes first)
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Compare opioid consumption in morphine milligram equivalents (MMEs) between groups intraoperatively, in PACU, and during the total hospital period.
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From date of procedure through hospital discharge (up to 30 days after procedure date, whichever comes first)
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Patient Satisfaction
Aikaikkuna: post operative day 1 and 5
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Compare patient satisfaction scores using a Likert scale on postoperative days 1 and 5. "The anesthesia care I received during my total knee arthroplasty (TKA) procedure met my expectations" (5= strongly agree, 1=strongly disagree) and "The management of any nausea and vomiting following my total knee arthroplasty (TKA) procedure met my expectations" (5= strongly agree, 1=strongly disagree).
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post operative day 1 and 5
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Adverse Events
Aikaikkuna: These events will be assessed after immediate administration in the preoperative holding area and within 4 hours postoperatively
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Compare the adverse events that could be related to aprepitant vs. placebo between groups.
These events may include but are not limited to: injection site reactions, hypersensitivity reactions or skin reactions, abdominal discomfort, constipation or diarrhea, dizziness, hiccups, headache
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These events will be assessed after immediate administration in the preoperative holding area and within 4 hours postoperatively
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Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Yhteistyökumppanit
Yhteistyökumppanit
Tutkijat
Tutkijat
- Päätutkija: Steven Greenberg, MD, Endeavor Health
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Opiskelun aloitus
Ensisijainen valmistuminen (Arvioitu)
Ensisijainen valmistuminen
Opintojen valmistuminen (Arvioitu)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Muita asiaankuuluvia MeSH-ehtoja
- Postoperatiiviset komplikaatiot
- Patologiset prosessit
- Merkit ja oireet, ruoansulatus
- Oksentelu
- Pahoinvointi
- Patologiset tilat, merkit ja oireet
- Merkit ja oireet
- Leikkauksen jälkeinen pahoinvointi ja oksentelu
- Heterosykliset yhdisteet, 1-rengas
- Heterosykliset yhdisteet
- Heterosykliset yhdisteet, 2-rengas
- Heterosykliset yhdisteet, sulatettu rengas
- Atsolit
- Polisykliset yhdisteet
- Imidatsolit
- Indolit
- Raskaat
- Raskaat
- Steroidit
- Sulatettu rengasyhdisteet
- Fluoratut steroidit
- Raskaat
- Morfoliinit
- Oksatsiinit
- Heterosykliset yhdisteet, 3-rengas
- Karbatsolit
- Aprepitantti
- Deksametasoni
- Ondansetroni
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- IRB2026-0126
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