- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT03618264
Pre-emptive Scalp Infiltration With Dexamethasone Plus Ropivacaine for Postoperative Pain After Craniotomy
Pre-emptive Scalp Infiltration With Dexamethasone Plus Ropivacaine vs. Ropivacaine for Relief of Postoperative Pain After Craniotomy in Adults
Studieoversikt
Status
Intervensjon / Behandling
Studietype
Registrering (Faktiske)
Fase
- Fase 4
Kontakter og plasseringer
Studiesteder
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Beijing, Kina, 100050
- Beijing Tiantan Hospital
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Patients scheduled for elective craniotomy for resection of a supratentorial tumour under general anaesthesia;
- American Society of Anesthesiologists (ASA) physical status of I or II;
- Participates required to fix their head in a head clamp intraoperatively;
- Participates with an anticipated fully recovery within 2 hours postoperatively.
Exclusion Criteria:
- History of craniotomy;
- Expected delayed extubation or no plan to extubate;
- Participants who cannot use a patient-controlled analgesia (PCA) device;
- Participants who cannot understand the instructions of a numeral rating scale (NRS) 35 before surgery;
- Extreme body mass index (BMI) (< 15 or > 35);
- Allergy to opioids, dexamethasone or ropivacaine;
- History of excessive alcohol or drug abuse, chronic opioid use (more than 2 weeks), or use of drugs with confirmed or suspected sedative or analgesic effects;
- History of psychiatric disorders, uncontrolled epilepsy or chronic headache;
- Pregnant or at breastfeeding;
- Symptomatic cardiopulmonary, renal, or liver dysfunction or history of diabetes;
- Preoperative Glasgow Coma Scale< 15;
- Suspicion of intracranial hypertension;
- Peri-incisional infection;
- Participants who have received radiation therapy and chemotherapy preoperatively or with a high probability to require a postoperative radiation therapy and chemotherapy according to the preoperative imaging.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Forebygging
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Dexamethasone plus Ropivacaine group
Participates received peri-incisional scalp infiltration of a miscible liquid of dexamethasone and ropivacaine.
The local infiltration miscible liquid containing 0.33mg dexamethasone and 5mg ropivacaine per milliliter
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Intervention in this study will be peri-incisional scalp infiltration with dexamethasone, ropivacaine and normal saline miscible liquids for participants who will undergo elective craniotomy.
The local infiltration solution containing 0.33mg dexamethasone and 5mg ropivacaine per milliliter will be infiltrated along the incision and throughout the entire thickness of the scalp before skin incision.
The volume of local infiltration solution will be decided by surgeons according to the cut length, and the capacity of the solution will be recorded by investigator.
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Aktiv komparator: Ropivacaine group
Participates received peri-incisional scalp infiltration of 5mg/mL ropivacaine.
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Intervention in this study will be peri-incisional scalp infiltration with ropivacaine for participants who will undergo elective craniotomy.
The local infiltration solution containing 5mg ropivacaine per milliliter will be infiltrated along the incision and throughout the entire thickness of the scalp before skin incision.
The volume of local infiltration solution will be decided by surgeons according to the cut length, and the capacity of the solution will be recorded by investigator.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Cumulative sufentanil consumption within 48 hours postoperatively
Tidsramme: Within 48 hours after the operation
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All participates will receive an electronic intravenous patient-controlled analgesia (PCA) device in which the bolus dose of sufentanil will be set as 2 μg with a lockout interval of 10 min and the maximum dose will be limited as 8 μg per hour.
If the participates feel inadequate analgesia after 5 times of sufentanil bolus, the bolus dose will be increased to 3 μg and the maximum dose will be increased to 12 μg per hour.
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Within 48 hours after the operation
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Første gang å trykke på den pasientkontrollerte analgesiknappen
Tidsramme: Innen 48 timer etter operasjonen
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Første gang deltakerne trykker på den pasientstyrte analgesiknappen.
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Innen 48 timer etter operasjonen
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Postoperativ kvalme og oppkast
Tidsramme: 2 timer, 4 timer, 8 timer, 24 timer, 48 timer etter operasjonen
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Postoperativ kvalme og oppkast (PONV) ble vurdert av deltakerne som: 0, fraværende; 1, kvalme som ikke krever behandling; 2, kvalme som krever behandling; og 3, oppkast.
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2 timer, 4 timer, 8 timer, 24 timer, 48 timer etter operasjonen
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Respirasjonsdepresjon
Tidsramme: Innen 48 timer etter operasjonen
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Respirasjonsdepresjon er definert som en respirasjonsfrekvens på mindre enn 10 pust per minutt eller oksygenmetning var mindre enn nitti prosent.
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Innen 48 timer etter operasjonen
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Tidene for nødsenking av blodtrykket etter operasjonen
Tidsramme: Innen 48 timer etter operasjonen
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Kriteriene for behandling bestemmes av deltakerens ansvarlige kirurg. Tidspunktene for nødsenking av blodtrykket vil bli registrert av etterforskeren.
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Innen 48 timer etter operasjonen
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Verdens helseorganisasjon livskvalitet (WHOQOL)-BREF
Tidsramme: 1 måned, 3 måneder og 6 måneder etter operasjonen
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Livskvalitet vil bli målt ved hjelp av Verdens helseorganisasjon QoL-BREF (WHOQOL-BREF) spørreskjema.
WHOQOL-BREF er en forkortet versjon av WHOQOL-100-vurderingen.
WHOQOL-BREF er et selvrapporterende spørreskjema som inneholder 26 elementer og tar for seg 4 QOL-domener: fysisk helse (7 elementer), psykologisk helse (6 elementer), sosiale relasjoner (3 elementer) og miljø (8 elementer).
To andre elementer måler generell QOL og generell helse.
Hvert domenes gjennomsnittlige poengsum kan variere mellom 4 og 20, og en høyere poengsum indikerer høyere livskvalitet.
Gjennomsnittlig poengsum for elementer innenfor hvert domene brukes til å beregne domenepoengsummen.
En transformasjonsmetode konverterer domenepoeng til en skala fra 0-100.
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1 måned, 3 måneder og 6 måneder etter operasjonen
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Det totale forbruket av opioider under operasjonen
Tidsramme: Under prosedyren
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Under prosedyren
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Det totale forbruket av bedøvelse under operasjonen
Tidsramme: Under prosedyren
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Under prosedyren
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Totalt antall ganger deltakerne trykker på pasientkontrollert analgesi-knapp
Tidsramme: Innen 48 timer etter operasjonen
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Totalt antall ganger deltakerne trykker på pasientkontrollert analgesi-knapp inkludert effektive trykk og ineffektive trykk.
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Innen 48 timer etter operasjonen
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The number of participants who have no sufentanil consumption
Tidsramme: Within 48 hours after the operation
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The number of participants who have not pushed the button of patient-controlled analgesia pump.
Both of the initial dose and background infusion of the patient-controlled analgesia pump in this study will be set as 0. Participates will be advised to push the analgesic demand button if they feel pain.
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Within 48 hours after the operation
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Numerical rating scale of pain
Tidsramme: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 1 month, 3 months and 6 months after surgery
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Pain was assessed after surgery by a numerical rating scale (0 indicates no pain, 10 indicates the most severe pain imaginable).
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At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 1 month, 3 months and 6 months after surgery
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Ramsay Sedation Scale
Tidsramme: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Ramsey 1: Anxious, agitated, restless; Ramsey 2: Cooperative, oriented, tranquil; Ramsey 3: Responsive to commands only If Asleep; Ramsey 4: Brisk response to light glabellar tap or loud auditory stimulus; Ramsey 5: Sluggish response to light glabellar tap or loud auditory stimulus; Ramsey 6: No response to light glabellar tap or loud auditory stimulus
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At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Heart rate
Tidsramme: Before anesthesia induction, after anesthesia induction, after scalp infiltration, during skull drilling, mater cutting, skin closure and at 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Before anesthesia induction, after anesthesia induction, after scalp infiltration, during skull drilling, mater cutting, skin closure and at 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Mean arterial pressure
Tidsramme: Before anesthesia induction, after anesthesia induction, after scalp infiltration, during skull drilling, mater cutting, skin closure and at 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Before anesthesia induction, after anesthesia induction, after scalp infiltration, during skull drilling, mater cutting, skin closure and at 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery
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Patient satisfactory scale (PSS)
Tidsramme: At 48 hours, 1 week, 1 month, 3 months and 6 months after surgery
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0 for unsatisfactory, and 10 for very satisfied
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At 48 hours, 1 week, 1 month, 3 months and 6 months after surgery
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The duration of hospitalization after the operation
Tidsramme: Approximately 2 weeks after the operation
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Approximately 2 weeks after the operation
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Incisional related adverse events Incisional related adverse events
Tidsramme: Within 1 month after surgery
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Including delayed incisional healing, incisional infection, intracranial infection, scar healing
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Within 1 month after surgery
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Wound Healing Score
Tidsramme: At 3 weeks and 6 weeks after surgery
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Skin Healing 1: fully healed; 2: ≤3 cm in total not healed; 3: >3 cm not healed; 4: areas of necrosis ≤3 cm; 5: areas of necrosis >3 cm Infection 1: none; 2: ≤0.5-cm margin of redness; 3: more redness or superficial pus; 4: deep infection; not applicable Hair Regrowth 1: even regrowth along wound; 2: ≤3 cm not regrowing; 3: >3-6 cm not regrowing; 4: >6 cm not regrowing; not applicable |
At 3 weeks and 6 weeks after surgery
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Patient and Observer Scar Assessment Scale
Tidsramme: At 6 months after surgery
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The Patient and Observer Scar Assessment Scale includes subjective symptoms of pain and pruritus and consists of 2 numerical numeric scales: The Patient Scar Assessment Scale and the Observer Scar Assessment Scale.
It assesses vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion for a scar on a score of 1 (normal skin) to 10 (worst scar imaginable).
and it incorporates patient assessments of pain, itching, color, stiffness, thickness, relief and overall opinion.
Participants were asked to rate the severity of their scar compared to normal skin.
The overall opinion scale score ranged from 1 (normal skin) to 10 (very different from normal skin).
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At 6 months after surgery
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Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Fang Luo, MD, Beijing Tiantan Hospital
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Rocha-Filho PA. Post-craniotomy headache: a clinical view with a focus on the persistent form. Headache. 2015 May;55(5):733-8. doi: 10.1111/head.12563. Epub 2015 Apr 22.
- Tsaousi GG, Logan SW, Bilotta F. Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature. Pain Pract. 2017 Sep;17(7):968-981. doi: 10.1111/papr.12548. Epub 2017 Feb 23.
- Dunn LK, Naik BI, Nemergut EC, Durieux ME. Post-Craniotomy Pain Management: Beyond Opioids. Curr Neurol Neurosci Rep. 2016 Oct;16(10):93. doi: 10.1007/s11910-016-0693-y.
- Rahimi SY, Alleyne CH, Vernier E, Witcher MR, Vender JR. Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis. J Neurosurg. 2010 Feb;112(2):268-72. doi: 10.3171/2008.9.17689.
- Mordhorst C, Latz B, Kerz T, Wisser G, Schmidt A, Schneider A, Jahn-Eimermacher A, Werner C, Engelhard K. Prospective assessment of postoperative pain after craniotomy. J Neurosurg Anesthesiol. 2010 Jul;22(3):202-6. doi: 10.1097/ANA.0b013e3181df0600.
- Vallapu S, Panda NB, Samagh N, Bharti N. Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Scalp Block and Scalp Infiltration to Control Postcraniotomy Pain: A Double-Blind Randomized Trial. J Neurosci Rural Pract. 2018 Jan-Mar;9(1):73-79. doi: 10.4103/jnrp.jnrp_310_17.
- Chowdhury T, Garg R, Sheshadri V, Venkatraghavan L, Bergese SD, Cappellani RB, Schaller B. Perioperative Factors Contributing the Post-Craniotomy Pain: A Synthesis of Concepts. Front Med (Lausanne). 2017 Mar 1;4:23. doi: 10.3389/fmed.2017.00023. eCollection 2017.
- Akcil EF, Dilmen OK, Vehid H, Ibisoglu LS, Tunali Y. Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clin Neurol Neurosurg. 2017 Mar;154:98-103. doi: 10.1016/j.clineuro.2017.01.018. Epub 2017 Jan 30.
- Misra S, Koshy T, Suneel PR. Oral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial. J Neurosurg Anesthesiol. 2009 Oct;21(4):297-301. doi: 10.1097/ANA.0b013e3181ac7a31.
- Zhao C, Wang S, Pan Y, Ji N, Luo F. Pre-Emptive Incision-Site Infiltration with Ropivacaine Plus Dexamethasone for Postoperative Pain After Supratentorial Craniotomy: A Prospective Randomized Controlled Trial. J Pain Res. 2021 Apr 19;14:1071-1082. doi: 10.2147/JPR.S300943. eCollection 2021.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- Patologiske prosesser
- Postoperative komplikasjoner
- Smerte
- Nevrologiske manifestasjoner
- Smerter, postoperativt
- Hodepine
- Fysiologiske effekter av legemidler
- Sentralnervesystemdepressiva
- Autonome agenter
- Agenter fra det perifere nervesystemet
- Sensoriske systemagenter
- Bedøvelsesmidler
- Anti-inflammatoriske midler
- Antineoplastiske midler
- Antiemetika
- Gastrointestinale midler
- Glukokortikoider
- Hormoner
- Hormoner, hormonsubstitutter og hormonantagonister
- Antineoplastiske midler, hormonelle
- Anestesimidler, lokal
- Deksametason
- Ropivakain
Andre studie-ID-numre
- KY 2018-034-02-1
Plan for individuelle deltakerdata (IPD)
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