Prophylaxis Against Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy

NCT ID: NCT06017167

Last Updated: 2023-08-30

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

PHASE2

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-15

Study Completion Date

2023-10-31

Brief Summary

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The aim of the study is to compare antiemetic effects between dexmedetomidine and ondansteron in the first group versus dexamethasone and ondansteron in the second group.

The primary outcome in this study is incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy.

The secondary outcomes are:

* The severity of post operative nausea and vomiting.
* Use of rescue antiemetic drugs.
* Postoperative pain and sedation.

Detailed Description

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General anesthesia is widely used in several surgeries. It can cause some complications such as postoperative nausea and vomiting (PONV). PONV is more common in general anesthesia than spinal anesthesia. PONV remains an extremely significant challenge due to its complex mechanism, resulting in serious consequences. Therefore an effective way to prevent or arrest PONV is urgently needed as Also, it can cause electrolyte imbalance and aggravate bleeding that delay hospital discharge.

The causes of PONV are multifactorial and can largely be categorized as patient risk factors, anaesthetic technique, and surgical procedure. Antiemetics work on several different receptor sites to prevent or treat PONV.

No single antiemetic pharmaceutical has been provided to be a universal solution to PONV. In general, multimodal combination treatment has superior viability for PONV prophylaxis compared with monotherapy .

Because nausea and vomiting were defined as two separate phe-nomena, studies should report and evaluate the variables distinctly . While since few patients experience vomiting without nausea, the incidence of PONV and postoperative nau¬sea (PON) is fairly similar, thus original papers often do not try to distinguish these variables . So, if PONV but not PON was reported in trails, we considered the PONV variables as a very close substitute for PON; when both PONV and PON were reported simultaneously, we assessed the nausea values. The most com¬monly used time interval to measure the role of antiemetic is 24 hours 6.

Ondansetron is a serotonin receptor antagonist, which is very important in preventing nausea and vomiting due to surgery and chemotherapy; it exhibited an anti-vomiting effect by inhibiting 5-Hydroxytryptamine type 3 (5-HT3) receptors in the vomiting centre .

Dexmedetomidine is a potent and highly selective a2-adrenoceptor agonist, which binds to transmembrane G protein-binding receptor located in the brain and spinal cord. Since nausea and vomit¬ing may be induced by high catecholamine con¬centrations, a decrease of sympathetic tone could explain the antiemetic effect of dexme¬detomidine. Finally, consumption of intraopera¬tive opioids, which increases the risk of PONV , may be reduced through the use of dexmedetomidine It affects the functions of central nervous, circulatory systems and exhibits sedative, analgesic, sympatholytic properties. Recently, the effect of dexmedetomidine on PONV has been the focus of clinical researchers. Nevertheless, controversy about the effectiveness of dexmedetomidine for PONV is still ongoing, for different results reported in associated literature.

Glucocorticoids may exert an antiemetic effect by inhibiting inflammatory mediators and by interacting with serotonin, neurokinin, a-adrenergic receptors, and other receptors. Furthermore, several studies have shown that dexamethasone enhances the antiemetic efficacies of 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists.

Conditions

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Postoperative Nausea and Vomiting Laparoscopic Cholecystectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomly classified with computer generated random numbers into two equal groups (each group 35 patients) Group I: will receive Ondansetron 4mg + dexmedetomidine 0.5 ug/kg + normal saline to complete 10 ml. volume IV infusion over 10 minutes.

Group II: will receive Ondansetron 4mg + dexamethasone 8mg + normal saline to complete 10 ml volume IV ifusion over 10 minutes.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Double (Participant, Outcomes Assessor)

* The participants will be kept blind in both groups.
* Outcome assessors will be blinded as they will be anesthesia resident and nurse not participating in the study.

Study Groups

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Dexmedetomidine Group

will receive ondansetron 4mg + dexmedetomidine 0.5 ug/kg + normal saline to complete 10 ml. volume IV infusion over 10 minutes.

Group Type ACTIVE_COMPARATOR

Ondansetron 4mg + dexmedetomidine 0.5 ug/kg + normal saline .

Intervention Type DRUG

compare antiemetic effects between dexmedetomidine and ondansetron in the first group versus dexamethasone and ondansetron in the second group

Dexamethasone Group

will receive Ondansetron 4mg + dexamethasone 8mg + normal saline to complete 10 ml. volume IV infusion over 10 minutes.

Group Type ACTIVE_COMPARATOR

Ondansetron 4mg + dexamethasone 8mg + normal saline.

Intervention Type DRUG

Group II: Ondansetron 4mg + dexamethasone 8mg + normal saline.

Interventions

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Ondansetron 4mg + dexmedetomidine 0.5 ug/kg + normal saline .

compare antiemetic effects between dexmedetomidine and ondansetron in the first group versus dexamethasone and ondansetron in the second group

Intervention Type DRUG

Ondansetron 4mg + dexamethasone 8mg + normal saline.

Group II: Ondansetron 4mg + dexamethasone 8mg + normal saline.

Intervention Type DRUG

Other Intervention Names

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ondansetron 4mg (Zofran; GlaxoSmithKline, Alexandria, USA dexmedetomidine (Precedex; Ho-Spira Inc., Lake Forest, Illinois, USA ondansetron 4mg (Zofran; GlaxoSmithKline, Alexandria, USA dexamethasone; Amriya Pharmaceutical Industries, Egypt

Eligibility Criteria

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Inclusion Criteria

* 70 Female patients aged between 18 and 65 years
* ASA I or II
* patients scheduled for elective laparoscopic cholecystectomy surgery will be included in this study.

Exclusion Criteria

* Females above 65 years old.
* patients under 18 years old.
* ASA \> II.
* Obesity (BMI\>40 kgm2).
* Known hypersensitivity to drugs used in the study protocol.
* Comorbidities that were known to increase the risk of PONV (e.g. vestibular disease).
* Liver or renal dysfunction (liver enzyme or creatinine 1.5 times higher than normal).
* Alcoholism or drug abuse.
* Use of antiemetics and psychotropic drugs or glucocorticoids within 24 h before surgery.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Tanta University

OTHER

Sponsor Role lead

Responsible Party

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yasmine mohammed mahmoud mustafa eldeba

Resident doctor of Anaesthesia and ICU Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed A. Lotfy, PHD

Role: PRINCIPAL_INVESTIGATOR

Assistant Professor of Anesthesia and Intensive Care, Tanta Univ

Locations

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Tanta University hospitals

Tanta, Algharbia, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Yasmine M. Eldeba, BA

Role: CONTACT

0021097732321

Rehab S. Elkalla, PHD

Role: CONTACT

01285700765

Facility Contacts

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Sohair Soliman, professor

Role: primary

00201283929049

Rehab Elkalla, M.D

Role: backup

01285700765

References

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Rhodes VA, McDaniel RW. The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting. Oncol Nurs Forum. 1999 Jun;26(5):889-94.

Reference Type BACKGROUND
PMID: 10382187 (View on PubMed)

Other Identifiers

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PONV after lap cholecystectomy

Identifier Type: -

Identifier Source: org_study_id

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