Evaluation of Ketamine/Midazolam Deep Sedation vs. Fentanyl/Midazolam Moderate Sedation for Image-Guided Percutaneous Procedures in Interventional Radiology

NCT ID: NCT07040163

Last Updated: 2025-06-27

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

EARLY_PHASE1

Total Enrollment

252 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-03-07

Study Completion Date

2026-06-30

Brief Summary

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This study aims to reduce pain during interventional radiology (IR) procedures, making the experience better for patients. Typically, doctors use medications like fentanyl and midazolam for sedation. This research will focus on patients undergoing biopsies and drainage procedures, often associated with significant discomfort. Patients will be randomly assigned to receive either fentanyl/midazolam or ketamine/midazolam combinations for sedation. A coordinator will collect information on pain levels and satisfaction, as well as monitor any extra medications needed and side effects. The investigators hope to find that ketamine helps decrease pain and improves satisfaction compared to fentanyl, without increasing complications.

Detailed Description

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This project will provide the following major innovations:

1. Improve patient experience and satisfaction: Prospective demonstration that ketamine/midazolam results in decreased peri-procedure pain scores and increased satisfaction scores would justify the use of deep sedation in IR and potentially benefit thousands of patients undergoing painful procedures in IR units across the country.
2. Demonstrate the safety and feasibility of ketamine/midazolam sedation administered by IR providers: Showing that performing IR procedures with ketamine/midazolam is as safe or safer than performing the same procedures with fentanyl/midazolam will increase the scope of cases that IR providers can perform without the direct assistance of anesthesia providers and need for recovery in post-anesthesia care units.
3. Provide high level data to justify creation of societal guidelines: One barrier to IR physicians performing deep sedation may be an inability to obtain hospital privileges. Emergency medicine physicians have created societal guidelines to describe the use of deep sedation, enabling successful credentialing. Publishing high quality studies showing safety and efficacy would provide a framework for IR-specific practice guidelines.

The aims of the study are as follows:

Aim 1: Prospectively compare pain and satisfaction scores in patients undergoing IR procedures with either fentanyl/midazolam or ketamine/midazolam. Patients undergoing image-guided biopsy and drainage procedures will be randomized to receive fentanyl/midazolam or ketamine/midazolam. Patients' pain will be rated using the validated 10-point Numeric Rating Scale before, during and after the procedure, and be given questionnaires based on validated anesthesia satisfaction surveys after the procedure to assess their perception of the sedation regimen. Patient groups will be compared in terms of differences on pain scores and the satisfaction survey using two-tailed Mann-Whitney tests.

Aim 2: Prospectively compare the safety of using fentanyl/midazolam or ketamine/midazolam for sedation during IR procedures. Patient groups will be compared in terms of procedure-related adverse events (e.g., hemorrhage, pneumothorax) and sedation-related adverse events (e.g., respiratory compromise) using Fisher's exact tests.

Conditions

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Sedation Interventional Radiology Biopsy Drainage Procedure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

In this prospective, single-center, single-blind randomized study, all patients 18 years of age and older undergoing image-guided lung and bone biopsy and percutaneous drainage who are eligible for moderate or deep sedation will be recruited. Subjects will be randomized to receive fentanyl/midazolam or ketamine/midazolam using SPSS. Patients will be unaware of which regimen they ultimately receive.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Ketamine Sedation

This arm will utilize a ketamine/midazolam combination sedation for interventional radiology procedures instead of fentanyl/midazolam combination sedation.

Group Type EXPERIMENTAL

ketamine

Intervention Type DRUG

This is the experimental intervention to be used as an alternative sedation method to the other comparator intervention (fentanyl).

Midazolam

Intervention Type DRUG

Adjuvant administered in combination with either fentanyl (comparator) or ketamine (experimental).

Fentanyl Sedation

This arm of the study will receive the traditional fentanyl/midazolam combination sedation for the interventional radiology procedure.

Group Type ACTIVE_COMPARATOR

fentanyl

Intervention Type DRUG

This is the traditional (comparator) intervention used in interventional radiology procedure sedation.

Midazolam

Intervention Type DRUG

Adjuvant administered in combination with either fentanyl (comparator) or ketamine (experimental).

Interventions

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ketamine

This is the experimental intervention to be used as an alternative sedation method to the other comparator intervention (fentanyl).

Intervention Type DRUG

fentanyl

This is the traditional (comparator) intervention used in interventional radiology procedure sedation.

Intervention Type DRUG

Midazolam

Adjuvant administered in combination with either fentanyl (comparator) or ketamine (experimental).

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Planned to undergo image-guided bone biopsy, lung biopsy, or percutaneous drainage
* Eligible to receive ketamine or fentanyl sedation
* Any sex/gender, any race
* Aged 18-89

Exclusion Criteria

* Pregnant/lactating
* Incarceration
* Currently taking an opioid agonist/antagonist
* Food consumed in past 6-8 hours
* Allergies to drugs used in the study
* Lacks mental capacity for reporting pain scores
* Hypotension or respiratory failure precluding fentanyl sedation
* Uncontrolled hypertension precluding ketamine sedation
* Condition for which hypertension would be a concern
* Schizophrenia
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sarah & Pauline Maier Foundation, Inc.

OTHER

Sponsor Role collaborator

CAMC Health System

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amy R Deipolyi, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

CAMC Department of Interventional Radiology

Locations

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CAMC Memorial

Charleston, West Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Amy R Deipolyi, M.D., Ph.D.

Role: CONTACT

304-388-0193

Adam M Belcher, Ph.D.

Role: CONTACT

304-388-9920

Facility Contacts

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Amy R Deipolyi, M.D., Ph.D.

Role: primary

304-388-0193

Adam M Belcher, Ph.D.

Role: backup

304-388-9920

References

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Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011 Feb;57(2):109-114.e2. doi: 10.1016/j.annemergmed.2010.09.010.

Reference Type BACKGROUND
PMID: 20970888 (View on PubMed)

Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: a narrative review. Biomed Res Int. 2015;2015:749837. doi: 10.1155/2015/749837. Epub 2015 Oct 1.

Reference Type BACKGROUND
PMID: 26495312 (View on PubMed)

Lemos JN, Lemos LDCN, Solla DJF, Lemos DDCN, Modolo NSP. Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study. Braz J Anesthesiol. 2023 May-Jun;73(3):258-266. doi: 10.1016/j.bjane.2021.12.003. Epub 2021 Dec 25.

Reference Type BACKGROUND
PMID: 34963617 (View on PubMed)

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. doi: 10.1002/acr.20543. No abstract available.

Reference Type BACKGROUND
PMID: 22588748 (View on PubMed)

Cashman JN, Ng L. The management of peri- and postprocedural pain in interventional radiology: a narrative review. Pain Manag. 2017 Nov;7(6):523-535. doi: 10.2217/pmt-2017-0024. Epub 2017 Nov 10.

Reference Type BACKGROUND
PMID: 29125398 (View on PubMed)

Sutley SH, Kraut RA. A comparison of transcutaneous PO2 in patients sedated with diazepam-fentanyl or midazolam-fentanyl. Anesth Prog. 1989 May-Jun;36(3):93-7.

Reference Type BACKGROUND
PMID: 2638156 (View on PubMed)

Boggs SD, Barnett SR, Urman RD. The future of nonoperating room anesthesia in the 21st century: emphasis on quality and safety. Curr Opin Anaesthesiol. 2017 Dec;30(6):644-651. doi: 10.1097/ACO.0000000000000528.

Reference Type BACKGROUND
PMID: 28984638 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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24-1149

Identifier Type: -

Identifier Source: org_study_id

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