Safety and Feasibility Study of Enhanced Recovery in Pancreaticoduodenectomy

NCT ID: NCT01759706

Last Updated: 2014-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

123 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-10-31

Study Completion Date

2013-01-31

Brief Summary

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The purpose of this study is to assess the adherence to an enhanced recovery after surgery (ERAS) pathway and the impact of the ERAS protocol on postoperative short-term outcome in patients undergoing pancreaticoduodenectomy (PD).

Detailed Description

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A specific enhanced recovery after surgery (ERAS) protocol has been applied since October 2010 in consecutive patients undergoing pancreaticoduodenectomy (PD) in a high volume Institution. Patient compliance for each item has been assessed. Each ERAS patient was matched with a patient who received standard perioperative care. Match criteria were age, gender, malignant / benign disease, and PD prognostic score.

Conditions

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Pancreatic Neoplasms

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Enhanced Recovery After Surgery (ERAS)

Patients treated with enhanced recovery after surgery protocol: preadmission counselling, preoperative immunonutrition, no preoperative bowel preparation, epidural analgesia with naropin + sufentanil, no pre-anesthetic medication, intraoperative iv fluid restriction, PONV prophylaxis with ondansetron + dexamethasone, hypothermia prophylaxis, removal of nasogastric tube (NGT) at the end of surgery, postoperative mobilization program, solid food diet from POD 2, early stop of iv infusions and removal of urinary catheter.

Group Type EXPERIMENTAL

Enhanced recovery after surgery protocol

Intervention Type BEHAVIORAL

ERAS items implemented were: preadmission counselling, preoperative immunonutrition, no preoperative bowel preparation, epidural analgesia, no pre-anesthetic medication, intraoperative iv fluid restriction, PONV and hypothermia prophylaxis, removal of nasogastric tube (NGT) at the end of surgery, mobilization protocol, solid food diet from POD 2, early stop of iv infusions and removal of urinary catheter.

PONV prophylaxis with Ondansetron + Dexamethasone

Intervention Type DRUG

Postoperative nausea and vomiting prophylaxis with Ondansetron + Dexamethasone.

Postoperative mobilization program

Intervention Type OTHER

Patient mobilization for 2 hours on first postoperative day Patient mobilization for 4 hours on first postoperative day + assisted deambulation in the room Patient mobilization for 6 hours on first postoperative day + assisted deambulation in the ward

Epidural analgesia with naropin + sufentanil

Intervention Type DRUG

Midthoracic epidural analgesia with naropin 0.2 % plus sufentanil 0,5 mcg/mL

Preadmission counselling

Intervention Type BEHAVIORAL

Patient multidisciplinary preoperative counselling, including anesthesiologist, surgeon and nurse.

Standard perioperative care (Control)

Patients treated with standard care perioperative protocol: epidural analgesia with naropin + sufentanil, pre-anesthetic medication with diazepam, Preoperative bowel preparation with sodium phosphate, removal of nasogastric tube on POD 1, solid food diet from POD 4

Group Type ACTIVE_COMPARATOR

Standard perioperative care

Intervention Type PROCEDURE

Epidural analgesia, pre-anesthetic medication with diazepam, bowel preparation with oral assumption of sodium phosphate, removal of nasogastric tube on POD 1, solid food diet from POD 4

Epidural analgesia with naropin + sufentanil

Intervention Type DRUG

Midthoracic epidural analgesia with naropin 0.2 % plus sufentanil 0,5 mcg/mL

Pre-anesthetic medication with diazepam

Intervention Type DRUG

Premedication before general anesthesia

Preoperative bowel preparation with sodium phosphate

Intervention Type DRUG

Preoperative bowel preparation with oral assumption of sodium phosphate

Interventions

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Enhanced recovery after surgery protocol

ERAS items implemented were: preadmission counselling, preoperative immunonutrition, no preoperative bowel preparation, epidural analgesia, no pre-anesthetic medication, intraoperative iv fluid restriction, PONV and hypothermia prophylaxis, removal of nasogastric tube (NGT) at the end of surgery, mobilization protocol, solid food diet from POD 2, early stop of iv infusions and removal of urinary catheter.

Intervention Type BEHAVIORAL

Standard perioperative care

Epidural analgesia, pre-anesthetic medication with diazepam, bowel preparation with oral assumption of sodium phosphate, removal of nasogastric tube on POD 1, solid food diet from POD 4

Intervention Type PROCEDURE

PONV prophylaxis with Ondansetron + Dexamethasone

Postoperative nausea and vomiting prophylaxis with Ondansetron + Dexamethasone.

Intervention Type DRUG

Postoperative mobilization program

Patient mobilization for 2 hours on first postoperative day Patient mobilization for 4 hours on first postoperative day + assisted deambulation in the room Patient mobilization for 6 hours on first postoperative day + assisted deambulation in the ward

Intervention Type OTHER

Epidural analgesia with naropin + sufentanil

Midthoracic epidural analgesia with naropin 0.2 % plus sufentanil 0,5 mcg/mL

Intervention Type DRUG

Pre-anesthetic medication with diazepam

Premedication before general anesthesia

Intervention Type DRUG

Preadmission counselling

Patient multidisciplinary preoperative counselling, including anesthesiologist, surgeon and nurse.

Intervention Type BEHAVIORAL

Preoperative bowel preparation with sodium phosphate

Preoperative bowel preparation with oral assumption of sodium phosphate

Intervention Type DRUG

Other Intervention Names

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Zofran + Decadron Disufen Valium Phospho-Lax

Eligibility Criteria

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Inclusion Criteria

* All patients undergoing elective pancreaticoduodenectomy

Exclusion Criteria

* Intraoperative detection of metastatic disease (non-operability)
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ospedale San Raffaele

OTHER

Sponsor Role collaborator

Università Vita-Salute San Raffaele

OTHER

Sponsor Role lead

Responsible Party

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Marco Braga

Professor in Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Marco Braga, MD

Role: PRINCIPAL_INVESTIGATOR

Università Vita-Salute San Raffaele

Locations

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San Raffaele Hospital

Milan, MI, Italy

Site Status

Countries

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Italy

References

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Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V. Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg. 2008 Nov;95(11):1387-93. doi: 10.1002/bjs.6324.

Reference Type BACKGROUND
PMID: 18844251 (View on PubMed)

Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, Parks RW, Fearon KC, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CH; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg. 2013 Feb;37(2):240-58. doi: 10.1007/s00268-012-1771-1. No abstract available.

Reference Type BACKGROUND
PMID: 22956014 (View on PubMed)

Other Identifiers

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ERAS_PANCREAS 01

Identifier Type: -

Identifier Source: org_study_id