The Effects of Method of Anaesthesia on the Safety and Effectiveness of Radical Retropubic Prostatectomy

NCT ID: NCT05566405

Last Updated: 2022-10-04

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

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-27

Study Completion Date

2022-09-30

Brief Summary

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Prostate cancer is one of the most commonly diagnosed neoplasm in men worldwide. The gold standard of therapy is radical prostatectomy, a wide surgical excision of the neoplasm and can be performed either open, laparoscopic or robotic. The open retropubic approach, still performed today, can be completed under either general anaesthesia or combined (spinal/epidural) anaesthesia without any clear guideline on which one should be preferred.

In this study the investigators aim to evaluate general anaesthesia and combined (spinal/ epidural) anaesthesia in patients undergoing open retropubic radical prostatectomy and define whether these may have an impact on the oncological outcome and safety of the procedure.

Detailed Description

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Conditions

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Prostatic Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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General Anaesthesia

Patients undergoing open retropubic radical prostatectomy under general anaesthesia

Group Type ACTIVE_COMPARATOR

General Anaesthesia

Intervention Type PROCEDURE

All patients in the general anaesthesia group will be premedicated with intravenously administered (iv) midazolam (2mg) and fentanyl (100 mcg). Induction will be performed using intravenous propofol (2.5-3mg/kg) and lidocaine (40mg); dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg will also be administered. After successful tracheal intubation, total intravenous anaesthesia will be maintained by administering propofol (0.05 mg/kg/sec iv) and remifentanil (0.2 mcg/kg/sec iv). Pain management will be achieved by paracetamol (1g iv) and tramadol (100mg iv) whereas muscle relaxation by vecuronium (0.6 mg/kg iv).

Open Retropubic Radical Prostatectomy

Intervention Type PROCEDURE

All patients will undergo a nerve-sparing open retropubic radical prostatectomy

Combined (Epidural and Spinal) Anaesthesia

Patients undergoing open retropubic radical prostatectomy under combined (epidural and spinal) anaesthesia

Group Type ACTIVE_COMPARATOR

Combined (Epidural and Spinal) Anaesthesia

Intervention Type PROCEDURE

Combined (epidural and spinal) anaesthesia will be performed using an epidural 18G needle and a spinal 27G needle, in the L2-L3 or L3-L4 interspace. Induction will be carried out by spinal intrathecal administration of levobupivacaine (2.6-3ml of 0.5%) and mild sedation by midazolam (5mg iv in bolus). All patients will be administered dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg iv. Maintenance will be performed 75 minutes after induction and obtained using an epidural administration of levobupivacaine (4-5ml of 0.5%).

Open Retropubic Radical Prostatectomy

Intervention Type PROCEDURE

All patients will undergo a nerve-sparing open retropubic radical prostatectomy

Interventions

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General Anaesthesia

All patients in the general anaesthesia group will be premedicated with intravenously administered (iv) midazolam (2mg) and fentanyl (100 mcg). Induction will be performed using intravenous propofol (2.5-3mg/kg) and lidocaine (40mg); dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg will also be administered. After successful tracheal intubation, total intravenous anaesthesia will be maintained by administering propofol (0.05 mg/kg/sec iv) and remifentanil (0.2 mcg/kg/sec iv). Pain management will be achieved by paracetamol (1g iv) and tramadol (100mg iv) whereas muscle relaxation by vecuronium (0.6 mg/kg iv).

Intervention Type PROCEDURE

Combined (Epidural and Spinal) Anaesthesia

Combined (epidural and spinal) anaesthesia will be performed using an epidural 18G needle and a spinal 27G needle, in the L2-L3 or L3-L4 interspace. Induction will be carried out by spinal intrathecal administration of levobupivacaine (2.6-3ml of 0.5%) and mild sedation by midazolam (5mg iv in bolus). All patients will be administered dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg iv. Maintenance will be performed 75 minutes after induction and obtained using an epidural administration of levobupivacaine (4-5ml of 0.5%).

Intervention Type PROCEDURE

Open Retropubic Radical Prostatectomy

All patients will undergo a nerve-sparing open retropubic radical prostatectomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with localised prostate cancer
* Eligible for open retropubic radical prostatectomy

Exclusion Criteria

* Metastatic prostate cancer
* History of severe heart disease
* History of haemostasis disorders
* History of previous pelvic surgery
* History of lung disease
Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National and Kapodistrian University of Athens

OTHER

Sponsor Role collaborator

Sismanoglio General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Konstantinos Pikramenos

Principal Investigator, Urology Resident, MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Konstantinos Pikramenos, MD

Role: PRINCIPAL_INVESTIGATOR

2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

Iraklis Mitsogiannis, Assoc. Prof.

Role: STUDY_DIRECTOR

2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

Ioannis Varkarakis, Prof.

Role: STUDY_CHAIR

2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

Athanasios Papatsoris, Prof.

Role: STUDY_CHAIR

2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

Locations

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Sismanoglio General Hospital

Marousi, Attica, Greece

Site Status

Countries

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Greece

References

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Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7-33. doi: 10.3322/caac.21708. Epub 2022 Jan 12.

Reference Type BACKGROUND
PMID: 35020204 (View on PubMed)

Hatzinger M, Hubmann R, Moll F, Sohn M. [The history of prostate cancer from the beginning to DaVinci]. Aktuelle Urol. 2012 Jul;43(4):228-30. doi: 10.1055/s-0032-1324651. German.

Reference Type BACKGROUND
PMID: 23035261 (View on PubMed)

Lepor H. A review of surgical techniques for radical prostatectomy. Rev Urol. 2005;7 Suppl 2(Suppl 2):S11-7.

Reference Type BACKGROUND
PMID: 16985892 (View on PubMed)

Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007 Feb;204(2):201-8. doi: 10.1016/j.jamcollsurg.2006.11.011. Epub 2006 Dec 27.

Reference Type BACKGROUND
PMID: 17254923 (View on PubMed)

Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018 Mar 23;2(3):e088. doi: 10.5435/JAAOSGlobal-D-17-00088. eCollection 2018 Mar.

Reference Type BACKGROUND
PMID: 30211382 (View on PubMed)

Hinkelbein J, Lamperti M, Akeson J, Santos J, Costa J, De Robertis E, Longrois D, Novak-Jankovic V, Petrini F, Struys MMRF, Veyckemans F, Fuchs-Buder T, Fitzgerald R. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol. 2018 Jan;35(1):6-24. doi: 10.1097/EJA.0000000000000683.

Reference Type BACKGROUND
PMID: 28877145 (View on PubMed)

Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322-30. doi: 10.1002/nau.20041.

Reference Type BACKGROUND
PMID: 15227649 (View on PubMed)

Hawthorne G, Sansoni J, Hayes L, Marosszeky N, Sansoni E. Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates. J Clin Epidemiol. 2014 May;67(5):527-37. doi: 10.1016/j.jclinepi.2013.12.010.

Reference Type BACKGROUND
PMID: 24698296 (View on PubMed)

Other Identifiers

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PN 20511/14.10.2020

Identifier Type: -

Identifier Source: org_study_id

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