Dexmedetomidine Versus Ketamine as Adjuvants in Bariatric Surgery

NCT ID: NCT06738043

Last Updated: 2024-12-17

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-20

Study Completion Date

2025-12-20

Brief Summary

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This randomized controlled trial aims to compare the analgesic efficacy of dexmedetomidine infusion versus low-dose ketamine infusion as adjuvants in bariatric surgery. The study includes 90 patients undergoing bariatric surgery at Menoufia University Hospital, randomized into three groups: dexmedetomidine, ketamine, and control (placebo). Primary outcomes include total morphine consumption intra- and post-operatively. Secondary outcomes include postoperative pain scores, total analgesic consumption, time to first analgesic request, hemodynamic parameters, and patient satisfaction. This study seeks to explore safer, more effective pain management strategies to minimize opioid use in bariatric surgery patients.

Detailed Description

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This study is a prospective, randomized controlled interventional trial evaluating the analgesic efficacy and opioid-sparing effects of dexmedetomidine and low-dose ketamine as adjuvants in bariatric surgery. Ninety patients meeting the inclusion criteria will be enrolled and randomized into three groups:

* Dexmedetomidine Group: Patients will receive a bolus dose of dexmedetomidine (0.5 µg/kg) followed by a continuous infusion (0.5 µg/kg/h) until 10 minutes before the end of surgery.
* Ketamine Group: Patients will receive a bolus dose of ketamine (0.3 mg/kg) followed by a continuous infusion (0.3 mg/kg/h) until 10 minutes before the end of surgery.
* Control Group: Patients will receive an equal volume of normal saline as a placebo.

Objectives

The primary objective is to compare intra- and postoperative morphine consumption between groups. Secondary objectives include:

* Pain assessment using the Numeric Rating Scale (NRS) at multiple time points postoperatively.
* Time to first request for rescue analgesia.
* Hemodynamic stability (heart rate and mean arterial pressure).
* Patient satisfaction assessed using a 5-point scale.
* Incidence of adverse effects such as nausea, vomiting, bradycardia, and respiratory depression.

Study Protocol All patients will undergo standard preoperative assessments, including history, physical examination, and laboratory investigations. General anesthesia will be induced and maintained per institutional protocols. Postoperatively, pain management will follow a stepwise approach, with intravenous paracetamol as rescue analgesia.

Significance Given the high prevalence of obesity-related comorbidities, bariatric surgery patients are at increased risk for postoperative complications, particularly with opioid use. This study addresses the need for opioid-sparing pain management strategies, potentially reducing the risks of opioid-related adverse effects and improving patient outcomes.

Conditions

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Obesity Postoperative Pain Bariatric Surgery

Keywords

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Dexmedetomidine Ketamine Opioid-Sparing Analgesia Randomized Controlled Trial Pain Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized into three parallel groups: dexmedetomidine, ketamine, or control (placebo) groups, each receiving specific interventions based on the protocol.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
The allocation will be concealed using sequentially numbered, sealed envelopes. A nurse not involved in patient care will open the envelope after induction of anesthesia to assign patients to groups.

Study Groups

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Dexmedetomidine Group

Participants in this group will receive a bolus dose of dexmedetomidine (0.5 µg/kg ideal body weight) diluted in 0.9% normal saline over 10 minutes before induction of anesthesia. This will be followed by a continuous infusion of dexmedetomidine at 0.5 µg/kg/h until 10 minutes before the end of surgery.

Group Type EXPERIMENTAL

Dexmedetomidine infusion

Intervention Type DRUG

A bolus dose of dexmedetomidine (0.5 µg/kg ideal body weight) diluted in 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion at 0.5 µg/kg/h until 10 minutes before the end of surgery.

Ketamine Group

Participants in this group will receive a bolus dose of ketamine (0.3 mg/kg ideal body weight) diluted in 0.9% normal saline over 10 minutes before induction of anesthesia. This will be followed by a continuous infusion of ketamine at 0.3 mg/kg/h until 10 minutes before the end of surgery.

Group Type EXPERIMENTAL

Ketamine infusion

Intervention Type DRUG

A bolus dose of ketamine (0.3 mg/kg ideal body weight) diluted in 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion at 0.3 mg/kg/h until 10 minutes before the end of surgery.

Control Group

Participants in this group will receive a bolus dose of 0.9% normal saline over 10 minutes before induction of anesthesia. This will be followed by a continuous infusion of 0.9% normal saline until 10 minutes before the end of surgery.

Group Type PLACEBO_COMPARATOR

Normal Saline Infusion (Placebo)

Intervention Type DRUG

A bolus dose of 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion of 0.9% normal saline until 10 minutes before the end of surgery.

Interventions

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Dexmedetomidine infusion

A bolus dose of dexmedetomidine (0.5 µg/kg ideal body weight) diluted in 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion at 0.5 µg/kg/h until 10 minutes before the end of surgery.

Intervention Type DRUG

Ketamine infusion

A bolus dose of ketamine (0.3 mg/kg ideal body weight) diluted in 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion at 0.3 mg/kg/h until 10 minutes before the end of surgery.

Intervention Type DRUG

Normal Saline Infusion (Placebo)

A bolus dose of 0.9% normal saline is infused over 10 minutes before induction of anesthesia, followed by a continuous infusion of 0.9% normal saline until 10 minutes before the end of surgery.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients aged 18-60 years.
* Both sexes.
* Body mass index (BMI) \> 35 kg/m², scheduled for bariatric surgery.
* American Society of Anesthesiologists (ASA) physical status I-II.

Exclusion Criteria

* History of hypersensitivity to dexmedetomidine or ketamine.
* History of substance abuse or chronic opioid use.
* American Society of Anesthesiologists (ASA) physical status III or IV.
* Severe hepatic or renal impairment.
* Cardiopulmonary disorders.
* Severe diabetes mellitus.
* Psychiatric disorders, seizures, uncontrolled hypertension (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg), or heart block.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tanta University

OTHER

Sponsor Role lead

Responsible Party

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Ahmed Abdalla Shalaby

Anesthesiology, Intensive Care and Pain Management Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Ahmed A Shalaby, M.B.B.Ch

Role: CONTACT

Phone: 01020479848

Email: [email protected]

Other Identifiers

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11/2024ANET15

Identifier Type: -

Identifier Source: org_study_id