Effects of General Anesthesia and Spinal-Morphine Anesthesia on Recovery and Comfort After Benign Abdominal Hysterectomy

NCT ID: NCT00527332

Last Updated: 2012-01-26

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

180 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-03-31

Study Completion Date

2009-12-31

Brief Summary

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The purpose of this study is to determine whether spinal anesthesia combined with intrathecal morphine in abdominal hysterectomy on benign gynecological indications gives better outcome concerning duration of hospital stay and postoperative patient comfort than general anesthesia.

Detailed Description

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Conditions

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Hysterectomy (MeSH nr: E04.950.300.399)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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A

Spinal anesthesia combined with intrathecal morphine. Spinal anesthesia applied in intervertebral space L3/L4 or L2/L3 with hyperbaric bupivacaine 20 mg and morphine 0.2 mg intrathecally. Sedation with propofol.

Group Type ACTIVE_COMPARATOR

Bupivacain

Intervention Type DRUG

5 mg/mL, 4 mL intrathecally as a single dos

Morphine

Intervention Type DRUG

0.4 mg/mL; 0.5 mL intrathecally as a single dosage

Propofol

Intervention Type DRUG

2-5 mg/kg body weight/hours IV (intravenously) for sedation during the surgery

B

General anesthesia. General anesthesia induced with propofol, fentanyl and rocuronium, and maintained with propofol and oxygen in air. Rocuronium and fentanyl repeated when needed.

Group Type ACTIVE_COMPARATOR

Propofol

Intervention Type DRUG

Induction of anesthesia with 1-2 mg/kg body weight IV (intravenously). After intubation maintenance dosage of 6-10 mg/kg/hour IV during the surgery

Fentanyl

Intervention Type DRUG

100-200 microgram IV (intravenously) at start of anesthesia. 50-100 microgram IV on demand during surgery.

Rocuronbromid

Intervention Type DRUG

0.6 mg/kg body weight IV (intravenously) at induction of anesthesia. If additional muscle relaxation is needed during surgery 5-10 mg is injected IV. The drug is given only at induction of anesthesia and during surgery

Morphine

Intervention Type DRUG

5 mg is given IV (intravenously) before end of surgery

Interventions

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Bupivacain

5 mg/mL, 4 mL intrathecally as a single dos

Intervention Type DRUG

Morphine

0.4 mg/mL; 0.5 mL intrathecally as a single dosage

Intervention Type DRUG

Propofol

2-5 mg/kg body weight/hours IV (intravenously) for sedation during the surgery

Intervention Type DRUG

Propofol

Induction of anesthesia with 1-2 mg/kg body weight IV (intravenously). After intubation maintenance dosage of 6-10 mg/kg/hour IV during the surgery

Intervention Type DRUG

Fentanyl

100-200 microgram IV (intravenously) at start of anesthesia. 50-100 microgram IV on demand during surgery.

Intervention Type DRUG

Rocuronbromid

0.6 mg/kg body weight IV (intravenously) at induction of anesthesia. If additional muscle relaxation is needed during surgery 5-10 mg is injected IV. The drug is given only at induction of anesthesia and during surgery

Intervention Type DRUG

Morphine

5 mg is given IV (intravenously) before end of surgery

Intervention Type DRUG

Other Intervention Names

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Marcain spinal tung. ATC-code: N01BB01 Morfin Special ATC-code: N02AA01 ATC-code: N01AX10 ATC-code: N01AX10 ATC-code:N01AH01 Esmeron ATC-code: M03AC09 ATC-code: N02AA01

Eligibility Criteria

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Inclusion Criteria

* Female between 18 and 60 years of age.
* Scheduled for abdominal hysterectomy - total or subtotal -on benign gynecological indication.
* At least one ovary planned to be preserved at the hysterectomy.
* Can understand and communicate in Swedish
* Accept participation after written and verbal information and after signed informed consent.
* Has supervision at home after discharge from hospital during the first couple of days and has access to a telephone.

Exclusion Criteria

* Contra-indications against spinal or general anesthesia or the standard dosage of the study drugs
* ASA classification ≥ Class 3
* Postmenopausal women without HRT (hormone replacement therapy).
* Suspected gynecological malignancy
* Previously undergone bilateral oophorectomy
* Substantial physically disabled so that a normal recovery with early physical mobilization can not be anticipated.
* Mentally or severly psychic disabled
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Preben Kjolhede

OTHER

Sponsor Role lead

Responsible Party

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Preben Kjolhede

Associate professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Preben Kjölhede, MD, PhD

Role: STUDY_CHAIR

Department of Obstetrics and Gynecology, University Hospital, Linköping

Lena Nilsson, MD, PhD

Role: STUDY_DIRECTOR

Department of Anesthesiology, University Hospital, Linköping

Ninnie B. Wodlin, MD

Role: STUDY_DIRECTOR

Department of Obstetrics and Gynecology, University Hospital, Linköping

Kenneth Krohn, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Ostetrics and Gynecology, Vrinnevi Hospital, Norrköping

Lars Nordenberg, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesiology, Vrinnevi Hospital, Norrköping

Mats D. Karlsson, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Obstetrics and Gynecology, Ryhov Hospital, Jönköping

Veronica Annerhagen, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesiology, Ryhov Hospital, Jönköping

Christina Gunnervik, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Obstetrics and Gynecology, Värnamo Hospital

Magnus Trofast, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesiology, Värnamo Hospital

Tomasz Stypa, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Obstetrics and Gynecology, Eksjö Hospital

Albert Sundberg, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesiology, Eksjö Hospital

Locations

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Eksjö Hospital

Eksjö, , Sweden

Site Status

Ryhov Hospital

Jönköping, , Sweden

Site Status

University Hospital

Linköping, , Sweden

Site Status

Vrinnevi Hospital

Norrköping, , Sweden

Site Status

Värnamo Hospital

Värnamo, , Sweden

Site Status

Countries

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Sweden

References

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Vårdtid, funktionskapacitet och sjukskrivningstider efter hysterektomi. Nationella data från 6503 patienter opererade år 2000 och 2001. Återrapport från Nationella registret för kvalitetsutveckling inom gynekologisk kirurgi (Gynop-registret), SFOG, 2003.

Reference Type BACKGROUND

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002 Jun;183(6):630-41. doi: 10.1016/s0002-9610(02)00866-8.

Reference Type BACKGROUND
PMID: 12095591 (View on PubMed)

Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001 Feb 24;322(7284):473-6. doi: 10.1136/bmj.322.7284.473. No abstract available.

Reference Type BACKGROUND
PMID: 11222424 (View on PubMed)

Moller C, Kehlet H, Friland SG, Schouenborg LO, Lund C, Ottesen B. Fast track hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2001 Sep;98(1):18-22. doi: 10.1016/s0301-2115(01)00342-6.

Reference Type BACKGROUND
PMID: 11516794 (View on PubMed)

Persson P, Wijma K, Hammar M, Kjolhede P. Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study. BJOG. 2006 Sep;113(9):1023-30. doi: 10.1111/j.1471-0528.2006.01025.x.

Reference Type BACKGROUND
PMID: 16956334 (View on PubMed)

Ellstrom MA, Astrom M, Moller A, Olsson JH, Hahlin M. A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy. Acta Obstet Gynecol Scand. 2003 Sep;82(9):871-5. doi: 10.1080/j.1600-0412.2003.00216.x.

Reference Type BACKGROUND
PMID: 12911451 (View on PubMed)

Kjolhede P, Langstrom P, Nilsson P, Wodlin NB, Nilsson L. The impact of quality of sleep on recovery from fast-track abdominal hysterectomy. J Clin Sleep Med. 2012 Aug 15;8(4):395-402. doi: 10.5664/jcsm.2032.

Reference Type DERIVED
PMID: 22893770 (View on PubMed)

Kjolhede P, Borendal Wodlin N, Nilsson L, Fredrikson M, Wijma K. Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study. BJOG. 2012 Jul;119(8):998-1006; discussion 1006-7. doi: 10.1111/j.1471-0528.2012.03342.x. Epub 2012 May 9.

Reference Type DERIVED
PMID: 22568450 (View on PubMed)

Other Identifiers

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EudraCT nr 2006-002520-41

Identifier Type: -

Identifier Source: org_study_id

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