Opioid-free Anesthesia in Thyroidectomies

NCT ID: NCT05243940

Last Updated: 2023-04-26

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

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-07

Study Completion Date

2024-02-01

Brief Summary

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The aim of this study will be to investigate the effect of an opioid-free anesthesia regimen with a mixture of dexmedetomidine-lidocaine-ketamine in the same syringe versus fentanyl analgesia in elective thyroidectomies. Recovery parameters and nociception levels throughout the operation will be evaluated

Detailed Description

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In the usual anesthetic practice opioids are often administered in the perioperative period for intraoperative analgesia to control the nociceptive pathway of pain and post-surgical pain management. However, in recent years, opioid Free Anesthesia (OFA) has become increasingly popular, in which opioid administration is avoided intraoperatively and minimized or avoided in the postoperative period.

Opioid-free anesthesia (OFA) has been shown to decrease postoperative complications associated with opioids, include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression.

Therefore, the investigators aim to perform this study to determine a goal-directed approach, which targets adequate antinociception (e.g., by measuring nociceptive/antinociceptive balance) that could reduce the negative effects of excessive drug infusion, prevent postoperative pain and improve patient outcomes.

Conditions

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Pain, Post Operative Pain, Acute Pain, Chronic Pain, Neuropathic Pain, Nociceptive Ketamine Dexmedetomidine Lidocaine Fentanyl Analgesia Analgesics Analgesics Non-narcotic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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dexmedetomidine-ketamine-lidocaine (DKL) group

combination of dexmedetomidine-ketamine-lidocaine in one syringe

Group Type ACTIVE_COMPARATOR

dexmedetomidine-ketamine-lidocaine (DKL)

Intervention Type DRUG

patients will be administered 0.25 mcg/kg Dexmedetomidine in 100 mL of normal saline within 10 minutes. Followingly, they will receive 1 mL/10 kg of the solution containing ketamine, lidocaine and dexmedetomidine at predefined concentrations. As maintenance, they will be receiving

1mL/10kg/h of the aforementioned solution.

remifentanil (control) group

remifentanil infusion (TCI Minto protocol)

Group Type ACTIVE_COMPARATOR

remifentanil infusion

Intervention Type DRUG

remifentanil infusion under the Minto model (target controlled infusion-TCI aiming at 4ng/ml blood concentration

Interventions

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dexmedetomidine-ketamine-lidocaine (DKL)

patients will be administered 0.25 mcg/kg Dexmedetomidine in 100 mL of normal saline within 10 minutes. Followingly, they will receive 1 mL/10 kg of the solution containing ketamine, lidocaine and dexmedetomidine at predefined concentrations. As maintenance, they will be receiving

1mL/10kg/h of the aforementioned solution.

Intervention Type DRUG

remifentanil infusion

remifentanil infusion under the Minto model (target controlled infusion-TCI aiming at 4ng/ml blood concentration

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* adult patients
* American Society of Anesthesiologists (ASA) classification I-II
* elective thyroidectomy

Exclusion Criteria

* body mass index (BMI) \>35 kg/m2
* contraindications to local anesthetic administration
* systematic use of analgesic agents preoperatively
* chronic pain syndromes preoperatively
* neurological or psychiatric disease on treatment
* pregnancy
* severe hepatic or renal disease
* history of cardiovascular diseases/ arrhythmias/ conduction abnormalities
* bradycardia(\<55 beats/minute)
* drug or alcohol abuse
* language or communication barriers lack of informed consent
Minimum Eligible Age

25 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aretaieion University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Dr Kassiani Theodoraki

Professor of Anesthesiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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KASSIANI THEODORAKI, MD, PhD, DESA

Role: PRINCIPAL_INVESTIGATOR

Aretaieion University Hospital, National and Kapodistrian University of Athens, Greece

Locations

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General Hospital of Athens, "Georgios Gennimatas"

Athens, Attica, Greece

Site Status RECRUITING

Countries

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Greece

Central Contacts

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KASSIANI THEODORAKI, MD, PhD, DESA

Role: CONTACT

+306974634162

Rammi Devadze, MD

Role: CONTACT

+306949535388

Facility Contacts

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Rammi Devadze, MD

Role: primary

+306949535388

Antonia Dimakopoulou, MD, PhD

Role: backup

References

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Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014 Jun;112(6):991-1004. doi: 10.1093/bja/aeu137.

Reference Type BACKGROUND
PMID: 24829420 (View on PubMed)

Forget P. Opioid-free anaesthesia. Why and how? A contextual analysis. Anaesth Crit Care Pain Med. 2019 Apr;38(2):169-172. doi: 10.1016/j.accpm.2018.05.002. Epub 2018 Sep 13.

Reference Type BACKGROUND
PMID: 29775728 (View on PubMed)

Martin JL, Koodie L, Krishnan AG, Charboneau R, Barke RA, Roy S. Chronic morphine administration delays wound healing by inhibiting immune cell recruitment to the wound site. Am J Pathol. 2010 Feb;176(2):786-99. doi: 10.2353/ajpath.2010.090457. Epub 2009 Dec 30.

Reference Type BACKGROUND
PMID: 20042674 (View on PubMed)

Ziemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth. 2014 May;112(5):906-11. doi: 10.1093/bja/aet551. Epub 2014 Feb 18.

Reference Type BACKGROUND
PMID: 24554545 (View on PubMed)

Song JY, Choi H, Chae M, Ko J, Moon YE. The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: study protocol for a prospective randomized controlled trial. Trials. 2021 Mar 12;22(1):207. doi: 10.1186/s13063-021-05166-z.

Reference Type BACKGROUND
PMID: 33712080 (View on PubMed)

Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019 Aug;123(2):e312-e321. doi: 10.1016/j.bja.2019.03.024. Epub 2019 Apr 30.

Reference Type BACKGROUND
PMID: 31047645 (View on PubMed)

Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019 May;74(5):651-662. doi: 10.1111/anae.14582. Epub 2019 Feb 25.

Reference Type BACKGROUND
PMID: 30802933 (View on PubMed)

Other Identifiers

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annie-rammi

Identifier Type: -

Identifier Source: org_study_id

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