Lidocaine And Neuromonitoring in Thyroid Surgery

NCT ID: NCT04574947

Last Updated: 2024-03-21

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

PHASE4

Total Enrollment

110 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-25

Study Completion Date

2023-12-31

Brief Summary

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The aim of this study is to test the hypothesis that the quality of recovery with topical lidocaine is better than placebo.

Detailed Description

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The use of neuromonitoring in thyroid surgery imposes a number of special demands for anaesthetic management. Such demands include avoiding muscle relaxation and local anaesthesia. Maintaining a balance between the risk of awakening during surgery and excessively deep anaesthesia in fast track surgery is an important task for the anaesthesiologist.

Mild anaesthesia in the absence of muscle relaxation increases the risk of developing laryngeal reflexes, coughing during surgery, while excessively deep anaesthesia slows down recovery after surgery and increases the risk of arterial hypotension. The frequency and duration of arterial hypotension, as well as the depth of anesthesia assessed by the Bispectral index, are independent risk factors for postoperative cardiovascular complications and long-term mortality. On the other hand, coughing in response to irritation of the endotracheal tube during recovery from anesthesia is recognized as a risk factor for respiratory and cardiovascular complications, as well as postoperative wound insufficiency.

Optimization the anesthesia by intravenous infusion of lidocaine can improve anesthesia controllability, hemodynamic stability and overall anesthesia recovery rates. Local use of lidocaine, including filling the endotracheal tube cuff with its alkalinized solution, has also been shown to be effective in reducing the frequency of laryngeal reflexes upon awakening after surgery of varying duration. However, the efficacy and safety of local use of lidocaine under neuromonitoring conditions has not been studied. Despite recommendations to avoid the local use of lidocaine for tracheal intubation, there is evidence of the safety of this technique in the absence of a negative impact on the quality of neuromonitoring.

The purpose of this study is to test the hypothesis that the quality of recovery with topical lidocaine is better than placebo. At the same time, the investigators assume that recovery after surgery will be comparable with both local and intravenous use. Intergroup differences in arterial hypotension, depth of anesthesia and intraoperative neuromonitoring parameters will also be investigated.

Conditions

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Thyroid Neoplasm Parathyroid Neoplasms Anesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Intravenous lidocaine

Group Type ACTIVE_COMPARATOR

Intravenous lidocaine

Intervention Type DRUG

Lidocaine IV 1.5 mg / kg BMI will be administered during induction into anaesthesia followed by infusion at a dose of 1.5 mg / kg / h until the end of the surgery.

Intra-cuff placebo

Intervention Type PROCEDURE

The intubation tube will be lubricated 0.9% sodium chloride, the tube cuff will be filled with 0.9% sodium chloride solution.

Topical lidocaine

Group Type EXPERIMENTAL

Intravenous placebo

Intervention Type DRUG

During induction and maintenance of anaesthesia, 0.9% sodium chloride solution will be injected intravenously at a rate equivalent to lidocaine solution.

Intra-cuff lidocaine

Intervention Type PROCEDURE

The lidocaine solution will be applied to the intubation tube and the cuff will be filled with an alkalinised lidocaine solution.

Placebo

Group Type PLACEBO_COMPARATOR

Intravenous placebo

Intervention Type DRUG

During induction and maintenance of anaesthesia, 0.9% sodium chloride solution will be injected intravenously at a rate equivalent to lidocaine solution.

Intra-cuff placebo

Intervention Type PROCEDURE

The intubation tube will be lubricated 0.9% sodium chloride, the tube cuff will be filled with 0.9% sodium chloride solution.

Interventions

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Intravenous lidocaine

Lidocaine IV 1.5 mg / kg BMI will be administered during induction into anaesthesia followed by infusion at a dose of 1.5 mg / kg / h until the end of the surgery.

Intervention Type DRUG

Intravenous placebo

During induction and maintenance of anaesthesia, 0.9% sodium chloride solution will be injected intravenously at a rate equivalent to lidocaine solution.

Intervention Type DRUG

Intra-cuff lidocaine

The lidocaine solution will be applied to the intubation tube and the cuff will be filled with an alkalinised lidocaine solution.

Intervention Type PROCEDURE

Intra-cuff placebo

The intubation tube will be lubricated 0.9% sodium chloride, the tube cuff will be filled with 0.9% sodium chloride solution.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Planned thyroid surgery
* Age\> 45 years
* Signed informed consent to participate in the study

Exclusion Criteria

* Emergency surgery
* Redo surgery
* Contraindications for lidocaine use
* Pregnancy
* Enrolment to another randomised clinical trial within the last 30 days
Minimum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Saint Petersburg State University, Russia

OTHER

Sponsor Role lead

Responsible Party

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Efremov Sergey

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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St. Petersburg State University Hospital

Saint Petersburg, , Russia

Site Status

Countries

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Russia

Other Identifiers

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IOLANT

Identifier Type: -

Identifier Source: org_study_id

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