Evaluation of Post-operative Biochemical Recurrence in Patients Submitted to Radical Prostatectomy Under General Opioid-free Anesthesia Compared to Conventional General Anesthesia

NCT ID: NCT03212456

Last Updated: 2020-07-29

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

146 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-12

Study Completion Date

2020-12-30

Brief Summary

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The use of opioids facilitates angiogenesis and has a proven action in the immune system, mainly in the reduction of natural killer cell activity, favoring the migration of neoplastic cells and inhibiting humoral and cellular immunity. These factors may contribute to recurrence and tumor metastasis.

Therefore, could opioid-free anesthesia help reduce tumor recurrence? This is a prospective randomized controlled clinical trial in which patients undergoing radical prostatectomy will be evaluated by conventional means, which have moderate and high D'Amico criteria for tumor recurrence.

In the operating room, patients will be monitored, receive peripheral venoclysis and then randomized into two groups: in group I, the anesthetic induction will be done with pre oxygenation with 100% O2, propofol, cisatracurium, lidocaine and fentanyl; In group II the induction will be done with the same doses of propofol, cisatracurium, lidocaine and placebo.

In both groups maintenance of general anesthesia will be with propofol 1% target infusion controlled with model of Marsh target-controlled infusion plasma between 2.0 and 3.0 mcg / ml, ketamine, lidocaine and dexmedetomidine.

Both groups will receive blockade of the transverse plane of the ultrasound guided ultrasound, group I with placebo (saline 0.9% 20 ml on each side) and group II with ropivacaine 0.375% 20 ml on each side. And the postoperative analgesia will be based on anti-inflammatory and opioid analgesics (pca of morphine) according to the analgesic pain scale of the patients.

In the postoperative period, patients will be followed up for 2 years with serial doses of prostate specific antigen (PSA) to diagnose tumor recurrence (2 PSA measures\> 0.2 ng / ml) and will be evaluated in relation to analgesia, need for analgesia of Rescue with morphine, satisfaction with the anesthetic technique, adverse effects (nausea and vomiting).

The primary objective is to evaluate tumor biochemical recurrence after radical prostatectomy in patients undergoing opioid anesthesia compared to patients anesthetized without opioids. The secondary objectives are to evaluate the quality of analgesia with the two techniques, patient satisfaction with perioperative period, quality of anesthetic recovery and adverse effects (nausea and vomiting, pruritus and drowsiness).

Thus, to answer the hypothesis raised, 146 patients will be needed (73 in each group).

Detailed Description

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Conditions

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Prostate Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Opioid-free

The patients of this group will receive opioid-free anesthesia

Group Type EXPERIMENTAL

opioid-free group

Intervention Type DRUG

We'll study if the opioid-free anesthesia can reduce the biochemical recurrence of prostate cancer.

transversus abdominal plane block with ropivacaine

Intervention Type PROCEDURE

The opioid-free group will receive transversus abdominal plane block with ropivacaine 0,375% 20 ml each side

Non opioid-free

The patients in this group will receive the same induction and maintenance drugs of the experimental group but with fentanyl 3 - 5 mcg/kg on induction and during the procedure as needed.

Group Type ACTIVE_COMPARATOR

Opioid Group

Intervention Type DRUG

This group will receive fentanyl in the induction of anesthesia.

transversus abdominal plane block with placebo

Intervention Type PROCEDURE

the non-opioid free group will receive transversus abdominal plane block with physiological solution 0,9% 20 ml each side

Interventions

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opioid-free group

We'll study if the opioid-free anesthesia can reduce the biochemical recurrence of prostate cancer.

Intervention Type DRUG

Opioid Group

This group will receive fentanyl in the induction of anesthesia.

Intervention Type DRUG

transversus abdominal plane block with ropivacaine

The opioid-free group will receive transversus abdominal plane block with ropivacaine 0,375% 20 ml each side

Intervention Type PROCEDURE

transversus abdominal plane block with placebo

the non-opioid free group will receive transversus abdominal plane block with physiological solution 0,9% 20 ml each side

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Prostate Cancer;
* Intermediate to high risk of recurrence by D'Amico criteria (Gleason scale \> or = 7; PSA \> or = 10)

Exclusion Criteria

* Patient refuse;
* atrioventricular blockade;
* Coagulopathy;
* Other procedure at same time.
Minimum Eligible Age

40 Years

Maximum Eligible Age

80 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Instituto do Cancer do Estado de São Paulo

OTHER

Sponsor Role lead

Responsible Party

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Felipe Rangel

MD, Anesthesiologist, principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Instituto do Cancer do Estado de Sao Paulo - Icesp

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

References

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Rangel FP, Auler JOC Jr, Carmona MJC, Cordeiro MD, Nahas WC, Coelho RF, Simoes CM. Opioids and premature biochemical recurrence of prostate cancer: a randomised prospective clinical trial. Br J Anaesth. 2021 May;126(5):931-939. doi: 10.1016/j.bja.2021.01.031. Epub 2021 Mar 10.

Reference Type DERIVED
PMID: 33712224 (View on PubMed)

Other Identifiers

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NP 834/15

Identifier Type: -

Identifier Source: org_study_id

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