Atropine Versus Glycopyrrolate in Preventing Spinal Anesthesia Induced Hypotension in Lower Limb Surgeries

NCT ID: NCT03580889

Last Updated: 2018-08-16

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

PHASE4

Total Enrollment

138 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-15

Study Completion Date

2018-09-30

Brief Summary

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A study to compare between intravenous atropine and glycopyrrolate in preventing spinal anesthesia induced hypotension in patients undergoing major lower limb orthopedic surgeries. Hypotension is the most common complication in spinal anesthesia that can be life threatening. If this can be prevented patients comfort can be increased and satisfaction as well.

Detailed Description

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Conditions

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Lower Extremity Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Atropine sulphate

Atropine 5 mcg/kg diluted in normal saline to total volume of 2 ml is given intravenous 1 minute after giving intrathecal Bupivacaine 0.5% (Heavy) and patients vitals such as blood pressure, heart rate, SPO2 are monitored every 1 minute for 5 minutes ,then every 5 minutes for 30 minutes then every 10 minutes till end of surgery. Patient shifted to PACU where above vitals are monitored for 2 hrs then shifted to ward. Mean while any adverse outcomes such as nausea, vomiting, sweating, dry mouth is noted and treated accordingly

Group Type ACTIVE_COMPARATOR

Atropine

Intervention Type DRUG

Comparison between atropine, glycopyrrolate and Normal Saline

Glycopyrrolate

Glycopyrrolate 2.5 mcg / kg diluted in normal saline to total volume of 2 ml is given intravenous 1 minute after giving intrathecal Bupivacaine 0.5% (Heavy) and patients vitals such as blold pressure, heart rate, SPO2 are monitored every 1 minute for 5 minutes ,then every 5 minutes for 30 minutes then every 10 minutes till end of surgery. Patient shifted to PACU where above vitals are monitored for 2 hrs then shifted to ward. Mean while any adverse outcomes such as nausea, vomiting, sweating, dry mouth is noted and treated accordingly.

Group Type ACTIVE_COMPARATOR

Glycopyrrolate

Intervention Type DRUG

Comparison between glycopyrrolate, atropine and Normal saline

Normal Saline

Normal saline 2 ml is given intravenous 1 minute after giving intrathecal Bupivacaine 0.5% (Heavy) and patients vitals such as blold pressure, heart rate, SPO2 are monitored every 1 minute for 5 minutes ,then every 5 minutes for 30 minutes then every 10 minutes till end of surgery. Patient shifted to PACU where above vitals are monitored for 2 hrs then shifted to ward. Mean while any adverse outcomes such as nausea, vomiting, sweating, dry mouth is noted and treated accordingly.

Group Type ACTIVE_COMPARATOR

Normal Saline Flush, 0.9% Injectable Solution

Intervention Type DRUG

Comparison between Normal saline, atropine and glycopyrrolate

Interventions

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Atropine

Comparison between atropine, glycopyrrolate and Normal Saline

Intervention Type DRUG

Glycopyrrolate

Comparison between glycopyrrolate, atropine and Normal saline

Intervention Type DRUG

Normal Saline Flush, 0.9% Injectable Solution

Comparison between Normal saline, atropine and glycopyrrolate

Intervention Type DRUG

Other Intervention Names

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Normal Saline

Eligibility Criteria

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Inclusion Criteria

* ASA PS I and II,
* age 16 to 65,
* undergoing lower limb major orthopedic surgery,
* willing to participate

Exclusion Criteria

* Contra indication to spinal anesthesia,
* patient refusal,
* ASA PS \>III,
* cardiac diseases,
* hypertension \>160/ 100,
* arrhythmias,
* Acute coronary syndrome,
* patients taking beta-blockers,
* hepatic and pulmonary diseases
Minimum Eligible Age

16 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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B.P. Koirala Institute of Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Raju Thapamagar

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Dr. BishnuPokharel

Dharān, Sunsari, Nepal

Site Status RECRUITING

Countries

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Nepal

Central Contacts

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Bishnu Pokharel, Dr.

Role: CONTACT

025525555

Facility Contacts

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Bishnu Pokharel, Dr.

Role: primary

025525555

References

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Duncan CM, Hall Long K, Warner DO, Hebl JR. The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs. Reg Anesth Pain Med. 2009 Jul-Aug;34(4):301-7. doi: 10.1097/AAP.0b013e3181ac7f86.

Reference Type BACKGROUND
PMID: 19574862 (View on PubMed)

Paul g. Barash clinical anesthesia 7th edition

Reference Type BACKGROUND

Panning B, Lehnhardt E, Mehler D. [Transient low frequency hearing loss following spinal anesthesia]. Anaesthesist. 1984 Dec;33(12):593-5. German.

Reference Type BACKGROUND
PMID: 6528963 (View on PubMed)

Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P, Tuman KJ. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg. 2002 Sep;95(3):661-6, table of contents. doi: 10.1097/00000539-200209000-00031.

Reference Type BACKGROUND
PMID: 12198056 (View on PubMed)

Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992 Jun;76(6):906-16. doi: 10.1097/00000542-199206000-00006.

Reference Type BACKGROUND
PMID: 1599111 (View on PubMed)

Morikawa KI, Bonica JJ, Tucker GT, Murphy TM. Effect of acute hypovolaemia on lignocaine absorption and cardiovascular response following epidural block in dogs. Br J Anaesth. 1974 Sep;46(9):631-5. doi: 10.1093/bja/46.9.631. No abstract available.

Reference Type BACKGROUND
PMID: 4621170 (View on PubMed)

Reiz S, Nath S, Ponten E, Friedman A, Backlund U, Olsson B, Rais O. Effects of thoracic epidural block and the beta-1-adrenoreceptor agonist prenalterol on the cardiovascular response to infrarenal aortic cross-clamping in man. Acta Anaesthesiol Scand. 1979 Oct;23(5):395-403. doi: 10.1111/j.1399-6576.1979.tb01466.x.

Reference Type BACKGROUND
PMID: 43650 (View on PubMed)

Dobson PM, Caldicott LD, Gerrish SP, Cole JR, Channer KS. Changes in haemodynamic variables during transurethral resection of the prostate: comparison of general and spinal anaesthesia. Br J Anaesth. 1994 Mar;72(3):267-71. doi: 10.1093/bja/72.3.267.

Reference Type BACKGROUND
PMID: 8130043 (View on PubMed)

Coe AJ, Revanas B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia. 1990 Mar;45(3):241-3. doi: 10.1111/j.1365-2044.1990.tb14696.x.

Reference Type BACKGROUND
PMID: 2334037 (View on PubMed)

McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. Br J Anaesth. 1993 Jun;70(6):672-80. doi: 10.1093/bja/70.6.672.

Reference Type BACKGROUND
PMID: 8329261 (View on PubMed)

Sigdel S. Prophylactic use of iv atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly. A randomized controlled trial. J anesthesiol clin res.2015;4(1):5

Reference Type BACKGROUND

Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000 Jul;93(1):115-21. doi: 10.1097/00000542-200007000-00021.

Reference Type RESULT
PMID: 10861154 (View on PubMed)

Other Identifiers

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IRC/1087/017

Identifier Type: -

Identifier Source: org_study_id

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