Different Peribulbar Blocks With SPI-guided Anaesthesia for VRS (P&MSPIVRS)

NCT ID: NCT03413371

Last Updated: 2025-09-23

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

184 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-26

Study Completion Date

2022-12-20

Brief Summary

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The aim of this randomized trial is to assess the efficacy of preventive analgesia using different peribulbar blocks (PBB) under SPI-guided anaesthesia for vitreoretinal surgery (VRS), presence of PONV (postoperative nausea and vomiting) and oculocardiac reflex (OCR) and compare Numerical Rating Scale (NRS) with Surgical Pleth Index (SPI) for monitoring pain perception postoperatively.

Patients will receive general anaesthesia combined with either preventive PBB using either lidocaine with bupivacaine or bupivacaine or ropivacaine

Detailed Description

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Monitoring depth of anaesthesia using spectral entropy (SE) and quality of neuromuscular block are routine in modern anaesthesia, whereas monitoring of analgesia still requires further studies. Recently, the Surgical Pleth Index (SPI) was added as a surrogate variable showing the nociception-antinociception balance into abovementioned parameters constituting a novel approach in monitoring patients intraoperatively, known as adequacy of anaesthesia (AoA) or tailor-made anaesthesia.

Different options of local anesthetic mixtures used for peribulbar block result in different analgetic potency. PBB is supposed to reduce requirement for intraoperative narcotic analgesics when used together with general anaesthesia and therefore may reduce the rate of PONV, OCR and perception of postoperative pain.

The aim of the study is to investigate the influence of different PBBs on abovementioned outcomes.

Conditions

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Vitreoretinal Surgeries Postoperative Nausea and Vomiting Postoperative Pain Oculocardiac Reflex

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Crossover Assignment
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Single (Participant)

Study Groups

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0,5 % bupivacaine with of 2% lidocaine

in group BL patients in group BF will receive regional peribulbar block using a solution of 0,5% bupivacaine (2,5 ml) with 2% lidocaine (2,5 ml)

Group Type EXPERIMENTAL

paracetamol

Intervention Type DRUG

in group P patients will receive pre-emptive analgesia using intravenous infusion of acetaminophen in a single dose of 10-15 mg per kg of body weight

1 % Ropivacaine

Intervention Type DRUG

in group R patients will receive regional peribulbar block using a solution of 0,75 % ropivacaine (5 ml)

0,5 % bupivacaine

Intervention Type DRUG

in group B patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (5 ml)

0,5 % bupivacaine

in group B patients in group BF will receive regional peribulbar block using a solution of 0,5% bupivacaine (5 ml)

Group Type EXPERIMENTAL

paracetamol

Intervention Type DRUG

in group P patients will receive pre-emptive analgesia using intravenous infusion of acetaminophen in a single dose of 10-15 mg per kg of body weight

0,5 % bupivacaine with of 2% lidocaine

Intervention Type DRUG

in group BL patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (2,5 ml) with 2% lidocaine (2,5 ml)

1 % Ropivacaine

Intervention Type DRUG

in group R patients will receive regional peribulbar block using a solution of 0,75 % ropivacaine (5 ml)

1 % ropivacaine

in group RL patients in group BF will receive regional peribulbar block using a solution of 1% ropivacaine (5 ml)

Group Type EXPERIMENTAL

paracetamol

Intervention Type DRUG

in group P patients will receive pre-emptive analgesia using intravenous infusion of acetaminophen in a single dose of 10-15 mg per kg of body weight

0,5 % bupivacaine with of 2% lidocaine

Intervention Type DRUG

in group BL patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (2,5 ml) with 2% lidocaine (2,5 ml)

0,5 % bupivacaine

Intervention Type DRUG

in group B patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (5 ml)

paracetamol

in P group patients will receive preemptive analgesia using 1 gram of paracetamol before induction of general anaesthesia

Group Type EXPERIMENTAL

0,5 % bupivacaine with of 2% lidocaine

Intervention Type DRUG

in group BL patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (2,5 ml) with 2% lidocaine (2,5 ml)

1 % Ropivacaine

Intervention Type DRUG

in group R patients will receive regional peribulbar block using a solution of 0,75 % ropivacaine (5 ml)

0,5 % bupivacaine

Intervention Type DRUG

in group B patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (5 ml)

Interventions

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paracetamol

in group P patients will receive pre-emptive analgesia using intravenous infusion of acetaminophen in a single dose of 10-15 mg per kg of body weight

Intervention Type DRUG

0,5 % bupivacaine with of 2% lidocaine

in group BL patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (2,5 ml) with 2% lidocaine (2,5 ml)

Intervention Type DRUG

1 % Ropivacaine

in group R patients will receive regional peribulbar block using a solution of 0,75 % ropivacaine (5 ml)

Intervention Type DRUG

0,5 % bupivacaine

in group B patients will receive regional peribulbar block using a solution of 0,5% bupivacaine (5 ml)

Intervention Type DRUG

Other Intervention Names

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Bupivacaine Lidocaine ropivacaine bupivacaine

Eligibility Criteria

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Inclusion Criteria

* written consent to participate in the study written consent to undergo general anaesthesia alone or combined with different techniques of pre-emptive analgesia and vitreoretinal surgery

Exclusion Criteria

* history of allergy to local anaesthetics or paracetamol necessity of administration of vasoactive drugs influencing SPI monitoring pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Silesian University of Medicine

OTHER

Sponsor Role collaborator

Medical University of Silesia

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Medical University of Silesia

Sosnowiec, Silesian Voivodeship, Poland

Site Status

Countries

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Poland

References

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Gruenewald M, Herz J, Schoenherr T, Thee C, Steinfath M, Bein B. Measurement of the nociceptive balance by Analgesia Nociception Index and Surgical Pleth Index during sevoflurane-remifentanil anesthesia. Minerva Anestesiol. 2015 May;81(5):480-9. Epub 2014 Jul 17.

Reference Type RESULT
PMID: 25032676 (View on PubMed)

Gruenewald M, Ilies C, Herz J, Schoenherr T, Fudickar A, Hocker J, Bein B. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol-remifentanil anaesthesia. Br J Anaesth. 2013 Jun;110(6):1024-30. doi: 10.1093/bja/aet019. Epub 2013 Mar 6.

Reference Type RESULT
PMID: 23471754 (View on PubMed)

Gruenewald M, Ilies C. Monitoring the nociception-anti-nociception balance. Best Pract Res Clin Anaesthesiol. 2013 Jun;27(2):235-47. doi: 10.1016/j.bpa.2013.06.007.

Reference Type RESULT
PMID: 24012235 (View on PubMed)

Gruenewald M, Willms S, Broch O, Kott M, Steinfath M, Bein B. Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study. Br J Anaesth. 2014 May;112(5):898-905. doi: 10.1093/bja/aet485. Epub 2014 Feb 16.

Reference Type RESULT
PMID: 24535604 (View on PubMed)

Jaichandran VV, Raman R, Gella L, Sharma T. Local anesthetic agents for vitreoretinal surgery: no advantage to mixing solutions. Ophthalmology. 2015 May;122(5):1030-3. doi: 10.1016/j.ophtha.2014.11.026. Epub 2015 Jan 10.

Reference Type RESULT
PMID: 25582785 (View on PubMed)

Ghali AM. The efficacy of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in vitreoretinal surgery. Saudi J Anaesth. 2012 Jan;6(1):22-6. doi: 10.4103/1658-354X.93050.

Reference Type RESULT
PMID: 22412772 (View on PubMed)

Seidenari P, Santin G, Milani P, David A. Peribulbar and retrobulbar combined anesthesia for vitreoretinal surgery using ropivacaine. Eur J Ophthalmol. 2006 Mar-Apr;16(2):295-9. doi: 10.1177/112067210601600216.

Reference Type RESULT
PMID: 16703549 (View on PubMed)

Subramaniam R, Subbarayudu S, Rewari V, Singh RP, Madan R. Usefulness of pre-emptive peribulbar block in pediatric vitreoretinal surgery: a prospective study. Reg Anesth Pain Med. 2003 Jan-Feb;28(1):43-7. doi: 10.1053/rapm.2003.50032.

Reference Type RESULT
PMID: 12567343 (View on PubMed)

Fekrat S, Elsing SH, Raja SC, Campochiaro PA, de Juan E Jr, Haller JA. Eye pain after vitreoretinal surgery: a prospective study of 185 patients. Retina. 2001;21(6):627-32. doi: 10.1097/00006982-200112000-00010.

Reference Type RESULT
PMID: 11756886 (View on PubMed)

Calenda E, Olle P, Muraine M, Brasseur G. Peribulbar anesthesia and sub-Tenon injection for vitreoretinal surgery: 300 cases. Acta Ophthalmol Scand. 2000 Apr;78(2):196-9. doi: 10.1034/j.1600-0420.2000.078002196.x.

Reference Type RESULT
PMID: 10794256 (View on PubMed)

Sajedi P, Nejad MS, Montazeri K, Baloochestani E. Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anesthesia. Int J Prev Med. 2013 Nov;4(11):1258-65.

Reference Type RESULT
PMID: 24404359 (View on PubMed)

Calenda E, Quintyn JC, Brasseur G. Peribulbar anaesthesia using a combination of lidocaine, bupivocaine and clonidine in vitreoretinal surgery. Indian J Ophthalmol. 2002 Sep;50(3):205-8.

Reference Type RESULT
PMID: 12355695 (View on PubMed)

Mandelcorn M, Taback N, Mandelcorn E, Ananthanarayan C. Risk factors for pain and nausea following retinal and vitreous surgery under conscious sedation. Can J Ophthalmol. 1999 Aug;34(5):281-5.

Reference Type RESULT
PMID: 10486687 (View on PubMed)

Other Identifiers

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SilesianMUKOAiIT8

Identifier Type: -

Identifier Source: org_study_id

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