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Pain, Post OperativeNCT05243940

Opioid-free Anesthesia in Thyroidectomies

A study testing dexmedetomidine-ketamine-lidocaine (DKL) and remifentanil infusion in people with Pain, Post Operative and Pain, Acute, run by Aretaieion University Hospital at 1 site in Greece.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The aim of this study will be to investigate the effect of an opioid-free anesthesia regimen with a mixture of dexmedetomidine-lidocaine-ketamine in the same syringe versus fentanyl analgesia in elective thyroidectomies. Recovery parameters and nociception levels throughout the operation will be evaluated Read more about this study

Who is it for?
Ages 25 to 75 years
Conditions the study is for
Pain, Post Operative, Pain, Acute, Pain, Chronic
What is being tested?
dexmedetomidine-ketamine-lidocaine (DKL) and remifentanil infusion
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteGreece
Study dates
7 Mar 2022to 1 Feb 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 25 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • adult patients
  • American Society of Anesthesiologists (ASA) classification I-II
  • elective thyroidectomy

Who cannot join

  • body mass index (BMI) >35 kg/m2
  • contraindications to local anesthetic administration
  • systematic use of analgesic agents preoperatively
  • chronic pain syndromes preoperatively
  • neurological or psychiatric disease on treatment
  • pregnancy
Show all 11Show fewer
  • severe hepatic or renal disease
  • history of cardiovascular diseases/ arrhythmias/ conduction abnormalities
  • bradycardia(<55 beats/minute)
  • drug or alcohol abuse
  • language or communication barriers lack of informed consent

Trial locations and contacts

1 site in 1 country.

KASSIANI THEODORAKI, MD, PhD, DESA contact

+306974634162

ktheodoraki@hotmail.com

Rammi Devadze, MD contact

+306949535388

gurdevadze@gmail.com

Greece1 site, 1 recruiting
  • General Hospital of Athens, "Georgios Gennimatas"

    Athens, Attica

    Rammi Devadze, MD, +306949535388, gurdevadze@gmail.com

    Antonia Dimakopoulou, MD, PhD

    Recruiting

Other trials in Greece

About this study

Official title: Recovery Parameters and Nociception Levels in Opioid-free Versus Opioid Based Anesthesia for Thyroidectomy

The aim of this study will be to investigate the effect of an opioid-free anesthesia regimen with a mixture of dexmedetomidine-lidocaine-ketamine in the same syringe versus fentanyl analgesia in elective thyroidectomies. Recovery parameters and nociception levels throughout the operation will be evaluated

Read the detailed description

In the usual anesthetic practice opioids are often administered in the perioperative period for intraoperative analgesia to control the nociceptive pathway of pain and post-surgical pain management. However, in recent years, opioid Free Anesthesia (OFA) has become increasingly popular, in which opioid administration is avoided intraoperatively and minimized or avoided in the postoperative period.

Opioid-free anesthesia (OFA) has been shown to decrease postoperative complications associated with opioids, include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression.

Therefore, the investigators aim to perform this study to determine a goal-directed approach, which targets adequate antinociception (e.g., by measuring nociceptive/antinociceptive balance) that could reduce the negative effects of excessive drug infusion, prevent postoperative pain and improve patient outcomes.

Being tested
dexmedetomidine-ketamine-lidocaine (DKL), remifentanil infusion
Medical subject headings
Pain, Postoperative, Acute Pain, Chronic Pain, Neuralgia, Nociceptive Pain, Agnosia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • dexmedetomidine-ketamine-lidocaine (DKL)Drug

    patients will be administered 0.25 mcg/kg Dexmedetomidine in 100 mL of normal saline within 10 minutes. Followingly, they will receive 1 mL/10 kg of the solution containing ketamine, lidocaine and dexmedetomidine at predefined concentrations. As maintenance, they will be receiving

    1mL/10kg/h of the aforementioned solution.

  • remifentanil infusionDrug

    remifentanil infusion under the Minto model (target controlled infusion-TCI aiming at 4ng/ml blood concentration

Study groups in NCT05243940
Study groupRoleWhat they receive
dexmedetomidine-ketamine-lidocaine (DKL) groupActive comparatorcombination of dexmedetomidine-ketamine-lidocaine in one syringe
Receives: Drug: dexmedetomidine-ketamine-lidocaine (DKL)
remifentanil (control) groupActive comparatorremifentanil infusion (TCI Minto protocol)
Receives: Drug: remifentanil infusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. change from baseline in Quality of Recovery (QoR)-40 score after surgery

    The QoR-40 is used to measure functional recovery and has been validated in patients undergoing general surgical procedures. Five general quality-of-recovery dimensions are measured within the QoR-40: physical comfort (12 items), emotional state (9 items), physical independence (5 items), psychological support (7 items), and pain (7 items). Each item is graded on a five-point Likert scale, and the global scores range from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery)

    Measured: 24 hours postoperatively

  2. pain score on arrival to Post-Anesthesia Care Unit (PACU)

    pain score by the use of Numeric Rating Scale (NRS) on arrival to PACU, ranging from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: immediately postoperatively

  3. pain score at discharge from Post-Anesthesia Care Unit (PACU)

    pain score by the use of Numeric Rating Scale (NRS) at discharge from PACU, ranging from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: at discharge from Post Anesthesia Care Unit (PACU), approximately 1 hour postoperatively

  4. pain score 3 hours postoperatively

    pain score by the use of Numeric Rating Scale (NRS) 3 hours postoperatively, ranging from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 3 hours postoperatively

  5. pain score 6 hours postoperatively

    pain score by the use of Numeric Rating Scale (NRS) 6 hours postoperatively, ranging from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 6 hours postoperatively

  6. pain score 24 hours postoperatively

    pain score by the use of Numeric Rating Scale (NRS) 24 hours postoperatively, ranging from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 24 hours postoperatively

  7. Nociception Level

    Nociception Level as measured via the NOL (Nociception Level) index, whose values vary from 0 to 100 (100 represents the maximum level of nociception and 0 represents total absence of nociception). The aim of the current study will be to record percentage of operative time during which NOL levels will be <25

    Measured: intraoperatively

Secondary outcomes (15)
  1. remifentanil requirement during anesthesia

    rescue remifentanil required intraoperatively to maintain systolic arterial blood pressure and heart rate within the 20% of baseline value

    Measured: intraoperatively

  2. Post Anesthesia Care Unit (PACU) duration of stay

    duration of patient stay at PACU

    Measured: immediately postoperatively

  3. sedation on arrival to Post-Anesthesia Care Unit

    sedation will be assessed with a 5-point sedation scale, where: 1, patient perfectly conscious; 2, patient feels a little drowsy; 3, patient seems to be sleeping but immediately reacts to verbal stimulation; 4, patient seems to be sleeping but slowly reacts to verbal stimulation and 5, patient seems to be sleeping and does not react to verbal stimulation but does react to a stimulus such as shaking or pain

    Measured: immediately postoperatively

  4. sedation at discharge from Post-Anesthesia Care (PACU) Unit

    sedation will be assessed with a 5-point sedation scale, where: 1, patient perfectly conscious; 2, patient feels a little drowsy; 3, patient seems to be sleeping but immediately reacts to verbal stimulation; 4, patient seems to be sleeping but slowly reacts to verbal stimulation and 5, patient seems to be sleeping and does not react to verbal stimulation but does react to a stimulus such as shaking or pain

    Measured: at discharge from Post Anesthesia Care Unit (PACU), approximately 1 hour postoperatively

  5. time to first request for analgesia

    the time for the first patient request for analgesia will be noted

    Measured: during stay in Post-Anesthesia Care Unit (PACU), approximately 1 hour postoperatively

  6. morphine consumption in Post-Anesthesia Care Unit (PACU

    mg of morphine requested during patient PACU stay

    Measured: immediately postoperatively

  7. tramadol consumption in the first 48 hours

    patients will be followed for cumulative tramadol consumption for 48 hours postoperatively

    Measured: 48 hours postoperatively

  8. sleep quality

    subjective evaluation of sleep quality by patients, based on a sleep questionnaire (evaluation of sleep duration, number of nocturnal awakenings and marking of sleep quality)

    Measured: 24 hours postoperatively

  9. first mobilization after surgery

    patients will be questioned regarding the time at which they mobilized after surgery

    Measured: 24 hours postoperatively

  10. satisfaction from postoperative analgesia

    satisfaction from postoperative analgesia on a six-point Likert scale with 1 marked as minimal satisfaction and 6 as maximal satisfaction

    Measured: 24 hours postoperatively

  11. first fluid intake

    patients will be questioned regarding the time they had their first fluid intake

    Measured: 24 hours postoperatively

  12. first solid intake

    patients will be questioned regarding the time they had their first solid intake

    Measured: 24 hours postoperatively

  13. hospitalization time

    duration of hospital stay after surgery in hours

    Measured: 96 hours postoperatively

  14. side effects intraoperatively

    patients will be monitored for side-effects of the administered agents intraoperatively

    Measured: intraoperatively

  15. side effects postoperatively

    patients will be monitored for side-effects of the administered agents postoperatively

    Measured: 48 hours postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Feb 2022
  2. Study start7 Mar 2022
  3. Primary completion1 Feb 2024 (estimated)
  4. Study completion1 Feb 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05243940
Sponsor's protocol ID
annie-rammi
Status last verified
Apr 2023
First submitted
8 Feb 2022
Last updated
26 Apr 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014 Jun;112(6):991-1004. doi: 10.1093/bja/aeu137.

    PubMed 24829420
  • Forget P. Opioid-free anaesthesia. Why and how? A contextual analysis. Anaesth Crit Care Pain Med. 2019 Apr;38(2):169-172. doi: 10.1016/j.accpm.2018.05.002. Epub 2018 Sep 13.

    PubMed 29775728
  • Martin JL, Koodie L, Krishnan AG, Charboneau R, Barke RA, Roy S. Chronic morphine administration delays wound healing by inhibiting immune cell recruitment to the wound site. Am J Pathol. 2010 Feb;176(2):786-99. doi: 10.2353/ajpath.2010.090457. Epub 2009 Dec 30.

    PubMed 20042674
  • Ziemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth. 2014 May;112(5):906-11. doi: 10.1093/bja/aet551. Epub 2014 Feb 18.

    PubMed 24554545
  • Song JY, Choi H, Chae M, Ko J, Moon YE. The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: study protocol for a prospective randomized controlled trial. Trials. 2021 Mar 12;22(1):207. doi: 10.1186/s13063-021-05166-z.

    PubMed 33712080
  • Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019 Aug;123(2):e312-e321. doi: 10.1016/j.bja.2019.03.024. Epub 2019 Apr 30.

    PubMed 31047645
  • Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019 May;74(5):651-662. doi: 10.1111/anae.14582. Epub 2019 Feb 25.

    PubMed 30802933

Questions about this trial

What is this clinical trial studying?

A study testing dexmedetomidine-ketamine-lidocaine (DKL) and remifentanil infusion in people with Pain, Post Operative and Pain, Acute, run by Aretaieion University Hospital at 1 site in Greece.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 26 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Greece. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact KASSIANI THEODORAKI, MD, PhD, DESA (+306974634162, ktheodoraki@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

change from baseline in Quality of Recovery (QoR)-40 score after surgery (time frame: 24 hours postoperatively). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05243940, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Apr 2023.

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