Comparison of Opioid Based and Opioid Free Anaesthesia in Transsphenoidal Surgery

NCT ID: NCT03120234

Last Updated: 2019-07-08

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

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2017-12-31

Brief Summary

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This study has been planned to compare the effect of opioid free anaesthesia using dexmedetomidine and ketamine with opioid based anaesthesia using fentanyl in maintaining the intraoperative hemodynamic stability and recovery characteristics in patients undergoing Transsphenoidal surgery of pituitary tumors.

Detailed Description

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Opioid Free Anesthesia (OFA) is a technique where no intraoperative opioid is administered during the anesthetic management. Opioid free anesthesia is usually achieved through sympatholysis, analgesia, and anesthesia with dexmedetomidine and analgesia with low dose ketamine. In addition paracetamol and other non-steroidal anti inflammatory drugs (NSAIDS) may be used as adjuncts to the multi-modal pain regimen.

Dexmedetomidine, a highly selective agonist of the alpha2 adrenergic receptor, has many clinical benefits, such as sedation, analgesia, preventing unwanted stress responses and low risk of respiratory depression. Because of concern that opioids might cause perioperative respiratory depression, substitution with dexmedetomidine will be helpful with its analgesic and sympatholytic properties. Dexmedetomidine has shown to reduce minimum alveolar concentration (MAC) of inhalational anesthetics and the requirement of perioperative opioid by 30-50%. In neurosurgical patients, dexmedetomidine is helpful in maintaining intracranial pressure (ICP) and intraoperative hemodynamic stability, especially during intubation and extubation. It can allow for faster awakening and thus an earlier neurological examination by decreasing necessary volatile agent and opioid doses.

Ketamine, an N-methyl-d-aspartate(NMDA) antagonist, blunts central pain sensitization at sub-anesthetic doses (0.5 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures.Recent literature has suggested that adjuvant ketamine administration in mechanically ventilated patients has no cerebrovascular effects.

The present study has been planned to compare the effect of opioid free anesthesia using dexmedetomidine and ketamine with opioid based anesthesia using fentanyl in maintaining the intraoperative hemodynamic stability and recovery characteristics in patients undergoing TSS of pituitary tumors.

Conditions

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Opioid Free Anaesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Dexmedetomidine and ketamine

The group will receive loading dose of dexmedetomidine 1mcg/kg over 10 Min followed by a maintenance of 0.5 mcg/ kg/ hr.ketamine 0.5 mg/kg will be given as bolus at the time of induction.

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Ketamine

Intervention Type DRUG

fentanyl and placebo

pts will receive fentanyl 2mcg/kg as bolus over 10 Mon followed by 1 mcg/ kg/hr as maintenance, instead of ketamine placebo(0.9%saline ) will be given in control group

Group Type EXPERIMENTAL

Fentanyl

Intervention Type DRUG

Placebos

Intervention Type DRUG

o.9% normal saline will be used instead of ketamine

Interventions

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Dexmedetomidine

Intervention Type DRUG

Ketamine

Intervention Type DRUG

Fentanyl

Intervention Type DRUG

Placebos

o.9% normal saline will be used instead of ketamine

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* patients suffering significant pituitary adenocarcinomas posted for transsphenoidal resection of tumor
* age group between 18 to 65 yr
* Both males and females
* ASA physical status 1 to 2

Exclusion Criteria

* pts taking opioid for chronic pain
* Pregnant or nursing woman
* Preoperative GCS \<15
* HR\<50/min
* Patients with allergies to study medication
* Patients with psychiatric disorder
* Patients with unstable cardiorespiratory disorder
* Patients with hepatic and renal insufficiency
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Post Graduate Institute of Medical Education and Research, Chandigarh

OTHER

Sponsor Role lead

Responsible Party

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Ayyawar Hareesh

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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AYYAWAR HAREESH, MBBS

Role: PRINCIPAL_INVESTIGATOR

Post Graduate Institute of Medical Education and Research, Chandigarh

Locations

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Post graduation institute of medical education and research

Chandigarh, , India

Site Status

Countries

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India

Other Identifiers

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MK/2950/MD/13121

Identifier Type: -

Identifier Source: org_study_id

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