Spinal Fusions Steroid Study

NCT ID: NCT05287035

Last Updated: 2023-08-22

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

EARLY_PHASE1

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-07-01

Study Completion Date

2025-07-01

Brief Summary

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Current efforts to improve pain alleviation focus on non-opioid pharmaceuticals. Intravenous perioperative corticosteroid administration has been suggested as an alternative method for post-operative pain control. The evidence regarding perioperative intravenous corticosteroids to help alleviate post-operative pain is mixed. Some meta-analyses report decreased opioid consumption and decreased pain intensity after a variety of surgical procedures. However, a study of larger orthopedic procedures found no benefit. The catabolic and immunosuppressant effects of corticosteroids also pose issues with wound healing and infection, which can have severe consequences after spine surgery. There is limited data on the effect of perioperative intravenous steroid administration on pain alleviation in children having surgery to address spine deformity. A recent retrospective review demonstrated that perioperative corticosteroid administration was associated with a statistically significant decrease in opioid medication utilization among children and adolescents after spinal deformity surgery. While not increasing the risk of postoperative complications. The investigators hypothesize that the administration of perioperative intravenous dexamethasone will demonstrate a clinically meaningful and statistically significant decrease in postoperative pain intensity, need for opioid medications, time to ambulation, and length of stay in children recovering from surgery for spine deformity.

Detailed Description

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Conditions

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Spinal Fusion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study will be a double blinded (patient, surgeon) prospective randomized controlled trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
Patient and surgeon will be masked. Anesthesiologist will not be masked.

Study Groups

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Steroid injection

Dexamethasone will be injected 1 dose intraoperatively, 3 doses post-operatively every 8hrs

Group Type ACTIVE_COMPARATOR

Dexamethasone injection

Intervention Type DRUG

Dexamethasone will be injected at the dosage recommended by the FDA.

Saline solution

Saline will be injected 1 dose intraoperatively, 3 doses post-operatively every 8hrs

Group Type PLACEBO_COMPARATOR

Saline injection

Intervention Type OTHER

Saline will be injected for the placebo arm of the study.

Interventions

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Dexamethasone injection

Dexamethasone will be injected at the dosage recommended by the FDA.

Intervention Type DRUG

Saline injection

Saline will be injected for the placebo arm of the study.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Meets operative criteria for posterior spinal instrumented fusion for AIS
* Parental consent

Exclusion Criteria

* Revision procedure
* Other associated conditions which may alter the postoperative course
Minimum Eligible Age

10 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Texas at Austin

OTHER

Sponsor Role lead

Responsible Party

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Brian Kaufman

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Dell Children's Medical Center

Austin, Texas, United States

Site Status

Countries

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United States

References

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Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002 Mar-Apr;10(2):117-29. doi: 10.5435/00124635-200203000-00007.

Reference Type RESULT
PMID: 11929206 (View on PubMed)

Fletcher ND, Ruska T, Austin TM, Guisse NF, Murphy JS, Bruce RW Jr. Postoperative Dexamethasone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2020 Oct 21;102(20):1807-1813. doi: 10.2106/JBJS.20.00259.

Reference Type RESULT
PMID: 33086348 (View on PubMed)

Pobereskin LH, Sneyd JR. Does wound irrigation with triamcinolone reduce pain after surgery to the lumbar spine? Br J Anaesth. 2000 Jun;84(6):731-4. doi: 10.1093/oxfordjournals.bja.a013583.

Reference Type RESULT
PMID: 10895746 (View on PubMed)

Jirarattanaphochai K, Jung S, Thienthong S, Krisanaprakornkit W, Sumananont C. Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial. Spine (Phila Pa 1976). 2007 Mar 15;32(6):609-16; discussion 617. doi: 10.1097/01.brs.0000257541.91728.a1.

Reference Type RESULT
PMID: 17413463 (View on PubMed)

Wittayapairoj A, Wittayapairoj K, Kulawong A, Huntula Y. Effect of intermediate dose dexamethasone on post-operative pain in lumbar spine surgery: A randomized, triple-blind, placebo-controlled trial. Asian J Anesthesiol. 2017 Sep;55(3):73-77. doi: 10.1016/j.aja.2017.08.001. Epub 2017 Sep 18.

Reference Type RESULT
PMID: 28986051 (View on PubMed)

Sharma M, Gupta S, Purohit S, Goyal AK. The Effect of Intravenous Dexamethasone on Intraoperative and Early Postoperative Pain in Lumbar Spine Surgery: A Randomized Double-Blind Placebo-Controlled Study. Anesth Essays Res. 2018 Oct-Dec;12(4):803-808. doi: 10.4103/aer.AER_115_18.

Reference Type RESULT
PMID: 30662111 (View on PubMed)

Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, Perez-Flores D. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg. 2001 Jun;92(6):1473-6. doi: 10.1097/00000539-200106000-00024.

Reference Type RESULT
PMID: 11375828 (View on PubMed)

Fletcher ND, Shourbaji N, Mitchell PM, Oswald TS, Devito DP, Bruce RW. Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis. J Child Orthop. 2014 May;8(3):257-63. doi: 10.1007/s11832-014-0587-y. Epub 2014 Apr 27.

Reference Type RESULT
PMID: 24770995 (View on PubMed)

Munro HM, Walton SR, Malviya S, Merkel S, Voepel-Lewis T, Loder RT, Farley FA. Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents. Can J Anaesth. 2002 May;49(5):461-6. doi: 10.1007/BF03017921.

Reference Type RESULT
PMID: 11983659 (View on PubMed)

Lee CS, Merchant S, Chidambaran V. Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis. Paediatr Drugs. 2020 Dec;22(6):575-601. doi: 10.1007/s40272-020-00423-1. Epub 2020 Oct 23.

Reference Type RESULT
PMID: 33094437 (View on PubMed)

Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative emesis and pain. Br J Anaesth. 1998 Jan;80(1):85-6. doi: 10.1093/bja/80.1.85.

Reference Type RESULT
PMID: 9505784 (View on PubMed)

Romundstad L, Breivik H, Niemi G, Helle A, Stubhaug A. Methylprednisolone intravenously 1 day after surgery has sustained analgesic and opioid-sparing effects. Acta Anaesthesiol Scand. 2004 Nov;48(10):1223-31. doi: 10.1111/j.1399-6576.2004.00480.x.

Reference Type RESULT
PMID: 15504180 (View on PubMed)

Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg. 1998 Aug;87(2):319-23. doi: 10.1097/00000539-199808000-00015.

Reference Type RESULT
PMID: 9706923 (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 RESULT
PMID: 23220857 (View on PubMed)

Other Identifiers

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STUDY00002340

Identifier Type: -

Identifier Source: org_study_id

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