Effect of Dexamethasone Shortly Before Surgery on the Intraoperative Dose of Remifentanil

NCT ID: NCT05002361

Last Updated: 2021-08-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 94 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-14
• Study Completion Date: 2020-06-07

Brief Summary

This explorative post hoc analysis included patients randomized in the DEX-2-TKA trial (NCT03506789) who were operated under general anesthesia with remifentanil and propofol. Patients having general anesthesia with sevoflurane were excluded. As the two groups receiving preoperative dexamethasone were identical at the time of outcome assessment, they were merged to one and were compared with placebo.

Detailed Description

The DEX-2-TKA was a randomized, blinded, placebo-controlled, multicenter trial in participants undergoing primary TKA conducted to investigate the effects of dexamethasone on morphine consumption, levels of postoperative pain, and harm. The methodology has been described in detail in the primary publication (ref), the protocol article and in the statistical analysis plan. In short, the trial was conducted at one private and four public Danish hospitals. Patients were randomized into one of three groups receiving either: Dexamethasone + placebo, dexamethasone + dexamethasone or placebo + placebo in a 1:1:1 ratio. The first dose of trial medication (intravenous dexamethasone 24 mg or placebo) was administered immediately after onset of anesthesia. Twenty-four hours after end of surgery, the second dose (dexamethasone 24 mg or placebo) was administered.

As the two groups receiving preoperative dexamethasone were identical at the time of outcome assessment for thi post-hoc analysis, they were merged to one and were compared with placebo yielding a ratio of 2:1 between the groups recieving dexamethsone and the placebo group.

Patients received either spinal anesthesia or general anesthesia (remifentanil and propofol were preferred). Before end of surgery all patients received ondansetron iv 4 mg. For patients in general anesthesia, sufentanil (0.3 μg/kg) was administered. All participants were provided with a patient-controlled analgesia pump (morphine 1 mg/mL, bolus 2 mg, lock-out 6 minutes, no background infusion) for 24 hours postoperatively. Additional boluses of 2 mg morphine on participant request were allowed the first hour after cessation of anesthesia. All participants received a protocolled non-opioid analgesic pain alleviation regime comprised of oral paracetamol 1 g and ibuprofen 400 mg given 1 hour before and every 6 hours after surgery and the surgeon administered local infiltration analgesia intraoperatively according to a standardized regimen.

The present explorative post hoc analysis included patients randomized in the DEX-2-TKA trial who were operated under general anesthesia with remifentanil and propofol. Patients having general anesthesia with sevoflurane were excluded.

Conditions

Perioperative Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Treatment A+B

24 mg dexamethasone i.v. perioperatively

Group Type: ACTIVE_COMPARATOR

Dexamethasone

Intervention Type: DRUG

24 mg intravenous Dexamethasone (6 ml)

Placebo

Placebo (isotonic saline) i.v. perioperatively

Group Type: PLACEBO_COMPARATOR

Isotonic saline

Intervention Type: DRUG

6 ml of isotonic saline

Interventions

Dexamethasone

24 mg intravenous Dexamethasone (6 ml)

Intervention Type: DRUG

Isotonic saline

6 ml of isotonic saline

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Participation in DEX-2-TKA (NCT03506789)
• General anesthesia

Exclusion Criteria

• Spinal anestehesia
• Use of sevoflurane

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Bispebjerg Hospital

OTHER

Sponsor Role: collaborator

Naestved Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Kasper S Gasbjerg, MD

Role: PRINCIPAL_INVESTIGATOR

Naestved Hospital

Locations

Gildhøj Privathospital

Brøndby, , Denmark

Bispebjerg Hospital

Copenhagen, , Denmark

Sjællands Universitetshospital, Køge

Køge, , Denmark

Næstsved Sygehus

Næstved, , Denmark

Odense Universitetshospital

Odense, , Denmark

Countries

Denmark

References

Gantzel M, Gasbjerg KS, Hagi-Pedersen D, Meyhoff CS, Olsen MH, Mathiesen O, Jakobsen JC, Lunn TH. Effect of dexamethasone on intraoperative remifentanil dose in total knee arthroplasty surgery under general anaesthesia. Acta Anaesthesiol Scand. 2022 Oct;66(9):1070-1076. doi: 10.1111/aas.14118. Epub 2022 Aug 4.

Reference Type: DERIVED

PMID: 35908167 (View on PubMed)

Other Identifiers

SM1-MG-2021

Identifier Type: -

Identifier Source: org_study_id