Role of Dexamethasone in Multimodal Analgesia for Postoperative Pain in Thoracic Surgery

NCT ID: NCT04325984

Last Updated: 2020-03-30

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

Total Enrollment

62 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-08-29

Study Completion Date

2019-03-06

Brief Summary

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The aim of the study is to evaluate the analgesic properties of dexamethasone and to quantify the possible associated postoperative complications, such as wound infections and hyperglycaemia, in patients who underwent lobectomy, segmentectomy or atypical resection surgery with a mini-thoracotomy approach or video-assisted thoracoscopic surgery (VATS).

Detailed Description

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We designed an observational study, aimed to evaluate the possible reduction in morphine consumption in thoracic patients, who were administered dexamethasone compared to who didn't received the drug.

The research wants to assess the presence of additional analgesic properties, besides the well known antiemetic effect, in the intraoperative administration of dexamethasone, and the possible postoperative complications, such as wound infections and hyperglycaemia.

The rational is to ameliorate the anaesthesiological management, in particular with a view to a opioid-sparing analgesia in thoracic patients.

To do so, we enrolled thoracic patients, who underwent elective lobectomy, segmentectomy or atypical resection surgery with a mini-thoracotomy approach or video-assisted thoracoscopic surgery (VATS).

We selected two groups: one in which patients were administered dexamethasone 8 mg at the moment of induction, and the other one in which patients didn't received dexamethasone, but ondansetron 4 mg at the end of surgery. Both groups received other antiemetic drugs based on Apfel score and multimodal analgesia, comprising loco-regional analgesia, opioids and other analgesic drugs administration.

The we checked morphine consumption and Numerical Rating Scale (NRS) values for pain in the first 24 hours after surgery.

Moreover we evaluate Post-Operative Nausea and Vomiting (PONV), intra- and post-operative blood glucose levels and wound infection.

Conditions

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Dexamethasone Adverse Reaction Postoperative Pain Postoperative Thoracic Procedure Complication Analgesia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Dexamethasone group

Group of patients receiving dexamethasone 8 mg as part of the multimodal analgesia.

Dexamethasone

Intervention Type DRUG

To the Dexamethasone group, at the moment of the induction of anaesthesia, dexamethasone 8 mg is administered.

Control group

Group of patients receiving multimodal analgesia, not comprising dexamethasone; moreover, ondansetron 4 mg is administered for the control of PONV.

No interventions assigned to this group

Interventions

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Dexamethasone

To the Dexamethasone group, at the moment of the induction of anaesthesia, dexamethasone 8 mg is administered.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* BMI \< 30 kg/m2
* ASA I-III
* Lobectomy, segmentectomy or atypical resection surgery with a mini-thoracotomy approach or VATS

Exclusion Criteria

* Refusal by the patient to participate or patient unable to express his own consent
* Chronic therapy with medium-high doses of corticosteroids
* Chronic therapy with opioids
* METS ≤ 4, defining an overall decreased cardiovascular fitness
* Urgent or emergency surgery
* Allergy to the active ingredient of the drug used
* Kidney failure at stage III or more
* Liver failure
* Pregnancy
* Drug addiction, patients with a history of drug abuse
* Corrected Qt interval (QTc) \> 0,45 for males and 0,47 for women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Trieste

OTHER

Sponsor Role lead

Responsible Party

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Marzia Umari

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Umberto Lucangelo, MD PhD

Role: STUDY_DIRECTOR

University of Trieste

Marzia Umari, MD

Role: PRINCIPAL_INVESTIGATOR

University of Trieste

Locations

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Cattinara Hospital

Trieste, , Italy

Site Status

Countries

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Italy

References

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Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol. 2011 Feb;24(1):8-12. doi: 10.1097/ACO.0b013e3283414175.

Reference Type BACKGROUND
PMID: 21084984 (View on PubMed)

Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2014 Aug;28(4):1048-56. doi: 10.1053/j.jvca.2014.02.021. No abstract available.

Reference Type BACKGROUND
PMID: 25107721 (View on PubMed)

Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000 Jan;90(1):186-94. doi: 10.1097/00000539-200001000-00038.

Reference Type BACKGROUND
PMID: 10625002 (View on PubMed)

Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013 Feb;110(2):191-200. doi: 10.1093/bja/aes431. Epub 2012 Dec 5.

Reference Type BACKGROUND
PMID: 23220857 (View on PubMed)

Kakodkar PS. Routine use of dexamethasone for postoperative nausea and vomiting: the case for. Anaesthesia. 2013 Sep;68(9):889-91. doi: 10.1111/anae.12308. Epub 2013 Jul 15. No abstract available.

Reference Type BACKGROUND
PMID: 23848292 (View on PubMed)

Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care. 2016 Jan;39 Suppl 1:S4-5. doi: 10.2337/dc16-S003. No abstract available.

Reference Type BACKGROUND
PMID: 26696680 (View on PubMed)

Other Identifiers

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173_2018_DexaPOP

Identifier Type: -

Identifier Source: org_study_id

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