Nociception Level-guided Remifentanil Dosing in Children During General Anesthesia

NCT ID: NCT05725382

Last Updated: 2023-08-24

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

RECRUITING

Clinical Phase

NA

Total Enrollment

264 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-01

Study Completion Date

2025-11-01

Brief Summary

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The investigators aim to investigate whether administration of a short-acting opioid (remifentanil) guided by a pain monitor (nociceptive level monitor) during anesthesia, can reduce pain in children after surgery.

The investigators hypothesize that pain monitor-guided administration of remifentanil can reduce pain postoperatively compared with standard care.

Detailed Description

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NOL-guided analgesia has not previously been assessed in children, and it is unknown whether this additional monitoring has any clinical benefits in a pediatric population.

In the present study the investigators aim to investigate whether administration of perioperative remifentanil guided by the CE-certified Pain Monitoring Device monitor-PMD200™, also called NOL-monitor, can reduce pain (primary endpoint), opioid consumption and agitation in children aged 3-16 years undergoing surgery with intravenous anesthesia.

The investigators hypothesize that NOL-guided perioperative remifentanil administration can reduce postoperative pain compared with standard clinical care (remifentanil dosing based on hemodynamic variables).

All patients will receive standard analgesia and antiemetic administered perioperatively:

* IV paracetamol 15 mg/kg
* IV Ibuprofen 10 mg/kg, unless contraindicated
* IV Morphine 25-100 μg/kg according to the extent of surgery and the departments' standard, administered 30 minutes before end of surgery (will not be included in the total perioperative or postoperative opioid consumption)
* In case of minor surgery, 1-2 μg/kg fentanyl, according to the department's standard, may be administered instead of morphine at the discretion of the anesthetist (will not be included in the total perioperative or postoperative opioid consumption)
* Regional anesthesia may be provided at the discretion of the anesthetist
* IV ondansetron 100 μg/kg

Conditions

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Surgical Procedure, Unspecified

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Blinded, randomized, controlled multicenter trial with two parallel groups and a superiority design.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The patients and their relatives, outcome assessors, data analysts and PACU nurses will be blinded. However, the anesthesiologists and anesthesia nurses anesthetizing the child according to the NOL monitor/standard care cannot be blinded. The anesthesiologist and anesthesia nurses anesthetizing the child will not be involved in patient care after the patient leaves the theatre, nor in any clinical assessments, data collection or interpretation of adverse events.

Study Groups

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NOL-guided remifentanil dosing

Remifentanil dosing will preferentially be guided by the NOL index, but blood pressure and heart rate will be monitored and considered concurrently.

* If the NOL index is \> 25, remifentanil infusion will be increased.
* If the NOL index is \< 10 the remifentanil infusion rate will be reduced

Group Type EXPERIMENTAL

The NOL monitor (Pain Monitoring Device monitor-PMD200™)

Intervention Type DEVICE

NOL-guided perioperative remifentanil administration

Standard care remifentanil dosing

Remifentanil dosing will be administered according to standard care per institutional practice.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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The NOL monitor (Pain Monitoring Device monitor-PMD200™)

NOL-guided perioperative remifentanil administration

Intervention Type DEVICE

Other Intervention Names

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NOL-guided remifentanil dosing

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiology (ASA) class of 1-3
* Scheduled surgery requiring intraoperative opioid administration
* Planned maintenance anesthesia with propofol and remifentanil
* The trial subject's custody holders' must be able to understand the trial protocol, risks, and benefits, and provide signed informed consent

Exclusion Criteria

* Inability of the trial subject's custody holder to read or write Danish
* Children who cannot cooperate to the study assessments based on the investigators' evaluation. This may be children with mental disorders, visual disturbances, hearing or speech impairment etc. interfering with assessments.
* Arrythmias, either known arrythmias preoperatively or arrythmias detected within the first minutes perioperatively (in which case the patient will be excluded post- randomization).
* Allergy to the medicines used in the study
* Daily intake of opioids (morphine, oxycodone, ketobemidone, methadone, fentanyl) during the last 4 weeks
* Weight \< 10 kg
Minimum Eligible Age

3 Years

Maximum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pia Jaeger, MD, PhD

OTHER

Sponsor Role lead

Responsible Party

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Pia Jaeger, MD, PhD

Senior Registrar

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Pia Jæger, MD, PhD

Role: STUDY_CHAIR

Department of Anaesthesia, The Juliane Marie Center, Rigshospitalet

Locations

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Department of Anaesthesia, The Center of Head and Orthopaedics, Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Department of Anaesthesia, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Department of Anaesthesia, Sjællands Universitetshospital, Køge

Køge, , Denmark

Site Status NOT_YET_RECRUITING

Department of Anaesthesia, Vejle Sygehus

Vejle, , Denmark

Site Status NOT_YET_RECRUITING

Countries

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Denmark

Central Contacts

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Mette Lea Mortensen, MD

Role: CONTACT

35452227 ext. 0045

Pia Jæger, MD, PhD

Role: CONTACT

35454016 ext. 0045

Facility Contacts

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Morten Bøttger, MD, MMD

Role: primary

Mette Lea Mortensen, MD

Role: primary

Casper H Jørgensen, MD, PhD

Role: primary

Nick P Steen, MD

Role: primary

Other Identifiers

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NOL1-2022

Identifier Type: -

Identifier Source: org_study_id

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