Effect of a Low-Dose Ketamine-Dexmedetomidine-Based Opioid-Sparing Anesthesia Protocol on Postoperative Quality of Recovery After Percutaneous Nephrolithotomy
Effect of a Low-Dose Ketamine-Dexmedetomidine-Based Opioid-Sparing Anesthesia Protocol on Postoperative Quality of Recovery After Percutaneous Nephrolithotomy: A Randomized Controlled Trial
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large or complex kidney stones. Although effective, dilation of the surgical tract and the placement of a nephrostomy tube cause significant postoperative pain. Conventional general anesthesia relies heavily on opioid medications (such as fentanyl) for pain control; however, opioids can cause unwanted side effects, including nausea, vomiting, dizziness, sedation, and delayed bowel recovery.
The purpose of this clinical trial is to investigate whether an opioid-sparing general anesthesia protocol utilizing a combination of low-dose ketamine and dexmedetomidine improves overall postoperative quality of recovery in adult patients undergoing PCNL compared with standard opioid-based anesthesia.
Participants will be randomly assigned to one of two groups:
- Conventional Opioid-Based Group: Participants receive standard general anesthesia supplemented with intravenous fentanyl before induction and as needed during surgery to manage pain.
- Ketamine-Dexmedetomidine Group: Participants receive general anesthesia combined with an initial dose and continuous low-dose intravenous infusion of ketamine and dexmedetomidine throughout the surgery.
Following surgery, all participants will receive scheduled intravenous paracetamol, with rescue opioid pain medication (nalbuphine) available if pain levels reach a moderate-to-severe threshold.
The primary outcome of the study is the patient-reported Quality of Recovery-15 (QoR-15) score at 24 hours after surgery. Secondary outcomes include total intraoperative and postoperative opioid consumption, postoperative pain scores at rest and during movement, time to first rescue pain medication, anesthesia emergence and recovery times, incidence of postoperative nausea and vomiting, and potential side effects.
Panoramica dello studio
Stato
Intervento / Trattamento
Tipo di studio
Iscrizione (Stimato)
Fase
- Fase 4
Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Adult patients scheduled for elective percutaneous nephrolithotomy (PCNL) under general anesthesia.
- Age between 18 and 60 years.
- American Society of Anesthesiologists (ASA) physical status I or II.
- Expected surgical duration ≤ 2 hours.
- Ability to understand and complete the Quality of Recovery-15 (QoR-15) questionnaire.
- Signed written informed consent.
Exclusion Criteria:
- Patient refusal to participate.
- Known allergy or contraindication to ketamine, dexmedetomidine, fentanyl, or other study medications.
- Significant cardiovascular disease.
- Uncontrolled hypertension.
- Clinically significant bradycardia.
- Severe hepatic or renal impairment.
- Psychiatric illness or active psychosis.
- Chronic opioid use.
- Chronic pain syndromes requiring regular analgesics.
- Pregnancy.
- Conversion to open surgery.
- Inability to complete postoperative assessments.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Doppio
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
|
Comparatore attivo: Conventional Opioid-Based General Anesthesia
Participants receive standard general anesthesia induced with IV propofol, muscle relaxation maintained with IV cisatracurium, and anesthesia maintained with sevoflurane. Systemic analgesia is provided with IV fentanyl 2 µg/kg before induction, followed by 0.5 µg/kg IV boluses as clinically indicated by hemodynamic response. Postoperatively, all patients receive IV paracetamol 1 g every 8 hours, with IV nalbuphine 0.1 mg/kg available every 4 hours as rescue analgesia for NRS pain scores ≥ 4 (maximum single dose 20 mg). |
Intravenous fentanyl administered at a dose of 2 µg/kg before induction, followed by supplementary boluses of 0.5 µg/kg IV as needed according to intraoperative hemodynamic response. |
|
Sperimentale: Ketamine-Dexmedetomidine Opioid-Sparing Anesthesia
Participants receive opioid-sparing general anesthesia induced with IV propofol, muscle relaxation maintained with IV cisatracurium, and anesthesia maintained with sevoflurane. Analgesic maintenance is provided with an IV ketamine bolus of 0.25 mg/kg followed by a continuous infusion of 0.25 mg/kg/h, combined with an IV dexmedetomidine loading dose of 0.5 µg/kg over 10 minutes followed by an infusion of 0.3 µg/kg/h. Postoperatively, all patients receive IV paracetamol 1 g every 8 hours, with IV nalbuphine 0.1 mg/kg available every 4 hours as rescue analgesia for NRS pain scores ≥ 4 (maximum single dose 20 mg). |
Intravenous ketamine bolus of 0.25 mg/kg administered before induction, followed by a continuous infusion of 0.25 mg/kg/h. Combined with intravenous dexmedetomidine loading dose of 0.5 µg/kg administered over 10 minutes, followed by a continuous infusion of 0.3 µg/kg/h throughout surgery. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Quality of Recovery-15 (QoR-15) Score
Lasso di tempo: 24 hours postoperatively
|
The Quality of Recovery-15 (QoR-15) questionnaire assesses patient-reported recovery across five domains: physical comfort, physical independence, psychological support, pain, and emotional state. The tool consists of 15 items, each scored from 0 to 10, resulting in a total score ranging from 0 to 150. Higher scores represent better postoperative quality of recovery. |
24 hours postoperatively
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Collaboratori e investigatori
Sponsor
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Studia le date principali
Inizio studio (Stimato)
Completamento primario (Stimato)
Completamento dello studio (Stimato)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie urogenitali
- Dolore
- Manifestazioni neurologiche
- Complicanze postoperatorie
- Processi patologici
- Malattie urogenitali maschili
- Malattie renali
- Malattie urologiche
- Malattie urogenitali femminili
- Malattie urogenitali femminili e complicanze della gravidanza
- Urolitiasi
- Condizioni patologiche, segni e sintomi
- Segni e sintomi
- Dolore, Postoperatorio
- Nefrolitiasi
- Prodotti chimici organici
- Composti eterociclici, 1-anello
- Composti eterociclici
- Azoli
- Idrocarburi
- Ciclohexanes
- Cicloparaffins
- Idrocarburi, aliciclici
- Idrocarburi, ciclici
- Imidazoli
- Piperidine
- Dexmedetomidina
- Ketamina
- Fentanil
Altri numeri di identificazione dello studio
- Ketamine-Dex Recovery in PCNL
Informazioni su farmaci e dispositivi, documenti di studio
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