Comparison of Dexmedetomidine + Ketamine for Postoperative Pain in C-Section

NCT ID: NCT07022821

Last Updated: 2025-06-18

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

PHASE4

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-05-16

Study Completion Date

2025-08-31

Brief Summary

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This study aims to compare three different doses of dexmedetomidine, when combined with a fixed dose of ketamine, for pain control in women undergoing cesarean section. The goal is to find the most effective combination with the fewest side effects.

Detailed Description

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Caesarean section is associated with moderate-to-severe postoperative discomfort in a significant proportion of women, which can delay recovery and return to regular activities, disrupt mother-child bonding, affect maternal psychological well-being, and impede nursing. Furthermore, inadequate surgical pain treatment may result in hyperalgesia and chronic pain. Due to widespread misconceptions that analgesic medications or procedures may have detrimental effects on the mother or newborn, and because the severity of post-caesarean section pain is typically underestimated, pain following caesarean section is frequently under-treated.

Various analgesic therapy techniques include oral or parenteral opioids, nonsteroidal anti-inflammatory medications, and neuraxial blocks with or without adjuvants, with unclear efficacy and/or substantial adverse effects. While opioids are the gold standard for postoperative pain management, they are associated with respiratory depression, nausea, vomiting, and other adverse effects that increase patient suffering. In recent years, there has been a shift toward minimizing opioid use and developing guidelines for enhanced postpartum recovery. Studies have explored combining opioids with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), ketamine, clonidine, and dexmedetomidine for effective pain relief while avoiding opioid-related side effects.

Dexmedetomidine, a highly selective α2-agonist, is beneficial in reducing tension and anxiety. It may be effective in the management of postoperative pain due to its analgesic properties. Dexmedetomidine acts at spinal and supraspinal sites, producing antinociceptive effects via stimulation of α2-receptors in the locus coeruleus.

Ketamine has been shown to be an effective painkiller with few side effects when used in small doses. Its analgesic effects result from N-methyl-D-aspartate (NMDA) receptor antagonism, and it also interacts with opioid receptors in the brain and spinal cord. When combined with benzodiazepines, ketamine's adverse effects are further minimized.

The combination of ketamine and dexmedetomidine offers several benefits, including hemodynamic stability, absence of respiratory depression, improved postoperative analgesia, and smoother recovery. Previous work has demonstrated a synergistic effect when these agents are used together, providing excellent symptom relief while minimizing side effects.

This study seeks to address the current gap in literature regarding the comparative efficacy of different doses of dexmedetomidine combined with a fixed dose of ketamine for post-cesarean analgesia. It aims to evaluate three infusion doses of dexmedetomidine combined with ketamine using postoperative pain scores as the primary outcome measure. The findings may help optimize pain management protocols following cesarean section

Conditions

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Postoperative Pain Cesarean Section Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Low-Dose Dexmedetomidine

Dexmedetomidine 0.2 µg/kg/hr + Ketamine 0.25 mg/kg/hr infusion

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Dexmedetomidine infusion at one of the following doses:

Group A: 0.2 µg/kg/hr Group B: 0.3 µg/kg/hr Group C: 0.4 µg/kg/hr Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

ketamine

Intervention Type DRUG

Ketamine infusion at a fixed dose of 0.25 mg/kg/hr administered in all three groups.

Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

Medium-Dose Dexmedetomidine

Dexmedetomidine 0.3 µg/kg/hr + Ketamine 0.25 mg/kg/hr infusion

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Dexmedetomidine infusion at one of the following doses:

Group A: 0.2 µg/kg/hr Group B: 0.3 µg/kg/hr Group C: 0.4 µg/kg/hr Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

ketamine

Intervention Type DRUG

Ketamine infusion at a fixed dose of 0.25 mg/kg/hr administered in all three groups.

Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

High-Dose Dexmedetomidine

Dexmedetomidine 0.4 µg/kg/hr + Ketamine 0.25 mg/kg/hr infusion

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Dexmedetomidine infusion at one of the following doses:

Group A: 0.2 µg/kg/hr Group B: 0.3 µg/kg/hr Group C: 0.4 µg/kg/hr Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

ketamine

Intervention Type DRUG

Ketamine infusion at a fixed dose of 0.25 mg/kg/hr administered in all three groups.

Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

Interventions

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Dexmedetomidine

Dexmedetomidine infusion at one of the following doses:

Group A: 0.2 µg/kg/hr Group B: 0.3 µg/kg/hr Group C: 0.4 µg/kg/hr Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

Intervention Type DRUG

ketamine

Ketamine infusion at a fixed dose of 0.25 mg/kg/hr administered in all three groups.

Route of Administration: Intravenous Frequency: Continuous infusion during postoperative period

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Elective lower segment cesarean section
* American Society of Anesthesiologists (ASA) Physical Status II
* Provided informed consent

Exclusion Criteria

* Known drug allergy
* Presence of significant comorbidities
* Emergency surgery
* Documented psychiatric illness
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Fatima Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ahmed Naeem

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of Anesthesiology, Fatima Memorial Hospital

Lahore, Punjab Province, Pakistan

Site Status RECRUITING

Countries

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Pakistan

Central Contacts

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Ahmed Naeem, MBBS

Role: CONTACT

+923114681512

Other Identifiers

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FMH-KETODEX-CS-2025

Identifier Type: -

Identifier Source: org_study_id

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