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Postoperative Cognitive DysfunctionNCT05439707

Effects of Perioperative Transauricular Vagus Nerve Electrical Stimulation on POD, POCD and CPSP

A study testing transaricular vagus nerve stimulation and fake transaricular vagus nerve stimulation in people with Postoperative Cognitive Dysfunction and Postoperative Delirium, run by Xuzhou Central Hospital at 1 site in China.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) occur in 11-51% of patients after surgery, and its prevalence increases with age. The occurrence of delirium is associated with increased morbidity and mortality, prolonged hospital stay, worse functional recovery. Read more about this study

Who is it for?
Ages 50 to 80 years
What is being tested?
transaricular vagus nerve stimulation and fake transaricular vagus nerve stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
600 participants
Where
1 siteChina
Study dates
1 Oct 2022to 1 Sep 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 50 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 50 to 80 years old.
  • ASA grade I-Ⅲ.
  • elective knee or hip replacement.

Who cannot join

  • Mini-Mental State Examination (MMSE) score < 23.
  • Education years<7.
  • Peptic ulcer disease, serious cardiac-cerebral vascular disease.
  • Neurological or psychiatric disorders.
  • History of drug and alcohol abuse.
  • Hepatic and/or kidney dysfunction.
Show all 9Show fewer
  • BMI>35.
  • Patients on antidepressants.
  • ASA >Ⅲ.

Trial locations and contacts

1 site in 1 country.

Yangzi Zhu, Doctor contact

+86 18168779150

zhuyz@188.com

Rui Yao, Maser contact

+86 18761341804

yaorui_edu@163.com

China1 site
  • Xuzhou Central Hospital

    Changzhou, Jiangsu, 221009

    Xianchi Li, PhD, +86-0516-83956044, xzzxyykjk@163.com

Other trials in China

About this study

Official title: Effects of Perioperative Transauricular Vagus Nerve Electrical Stimulation on Postoperative Delirium, Postoperative Cognitive Dysfunction and Chronic Postsurgical Pain in Patients Undergoing Arthroplasty.

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) occur in 11-51% of patients after surgery, and its prevalence increases with age. The occurrence of delirium is associated with increased morbidity and mortality, prolonged hospital stay, worse functional recovery. Orthopedic procedures and specifically joint replacements have been considered as a major risk for development of chronic postsurgical pain (CPSP). Approximately 13-44% of patients will develop CPSP after knee or hip arthOpioid abuseroplasty. CPSP may cause the discomfort, distress, disability and opioid abuse. Mounting evidence has revealed that inflammation triggered by surgical trauma plays a key role in POD, POCD and CPSP. Recent studies found that vagus nerve stimulation showed the suppression of inflammation. In this study, the effect of perioperative transauricular vagus nerve stimulation on the prognosis of patients undergoing arthroplasty will be investigated, providing potential solutions for the prevention and treatment of postoperative cognitive dysfunction, postoperative delirium and chronic postsurgical pain.

Read the detailed description

The investigators assessed POD by the Confusion Assessment Method for the ICU twice daily for 7 days after surgery. Participants' cognitive function was assessed with neuropsychological battery tests. The tests included digit span (forward and backward), Corsi block, paired associate verbal learning, digit symbol test, trail-making test and so on.The investigators make a CPSP diagnosis based on the 11th revision of the International Classification of Diseases.

Being tested
transaricular vagus nerve stimulation, fake transaricular vagus nerve stimulation
Medical subject headings
Postoperative Cognitive Complications, Emergence Delirium, Pain, Postoperative

What participants receive

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

  • transaricular vagus nerve stimulationDevice

    The transaricular vagus nerve stimulator was placed in the left ear trunk, which is dominated only by the auricular branch of the vagus nerve. Continuous stimulation was performed at a frequency of 25Hz with pulse width of 300 μs. The stimulation was adjusted to be higher than the perception threshold and lower than the pain threshold. Each stimulation lasted for 30 minutes, three times per day (morning, noon, evening), from 1 day before surgery to 7 days after surgery, and the treatment lasted for 9 consecutive days.

  • fake transaricular vagus nerve stimulationDevice

    The transaricular vagus nerve stimulator was placed in the same position as the experimental group, covered with an insulating film and placed at the site of the stimulation, so that the patient could not actually receive the electrical stimulation. Continuous stimulation was performed at a frequency of 25Hz and pulse width of 300 μs, and the stimulation was adjusted to be higher than the perception threshold and lower than the pain threshold. Each stimulation lasted for 30 minutes, three times per day (morning, noon, evening), from 1 day before surgery to 7 days after surgery, for 9 consecutive days.

Study groups in NCT05439707
Study groupRoleWhat they receive
Experimental groupExperimentalThe transaricular vagus nerve stimulator was placed in the left ear trunk, which is dominated only by the auricular branch of the vagus nerve. Continuous stimulation was performed at a frequency of 25Hz with pulse width of 300 μs. The stimulation was adjusted to be higher than the perception threshold and lower than the pain threshold. Each stimulation lasted for 30 minutes, three times per day (morning, noon, evening), from 1 day before surgery to 7 days after surgery, and the treatment lasted for 9 consecutive days.
Receives: Device: transaricular vagus nerve stimulation
Control groupSham comparatorThe transaricular vagus nerve stimulator was placed in the same position as the experimental group, covered with an insulating film and placed at the site of the stimulation, so that the patient could not actually receive the electrical stimulation. Continuous stimulation was performed at a frequency of 25Hz and pulse width of 300 μs, and the stimulation was adjusted to be higher than the perception threshold and lower than the pain threshold. Each stimulation lasted for 30 minutes, three times per day (morning, noon, evening), from 1 day before surgery to 7 days after surgery, for 9 consecutive days.
Receives: Device: fake transaricular vagus nerve stimulation

What is being measured

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

  1. Postoperative cognitive function

    The incidence of POCD was compared between the experimental group and the control group.The preoperative and postoperative differences of the following scales were calculated and compared: Digit Span (forward and backward), Visual Retention and Paired Associate Verbal Learning subtests of the Wechsler Memory Scale, Digit Symbol subtest of the Wechsler Adult Intelligence ScaleRevised, Halstead-Reitan Trail Making Test (Part A), Corsi Block Test and Grooved Pegboard Test (favored and unfavored hand). The standard deviation (SD) for each test was computed from the preoperative scores. A participant whose postoperative performance declined by ≥1 SD as compared to each preoperative test score on ≥2 tests was classified as POCD.

    Measured: 1 month after the surgery.

  2. Postoperative cognitive function

    The incidence of POCD was compared between the experimental group and the control group.The preoperative and postoperative differences of the following scales were calculated and compared: Digit Span (forward and backward), Visual Retention and Paired Associate Verbal Learning subtests of the Wechsler Memory Scale, Digit Symbol subtest of the Wechsler Adult Intelligence ScaleRevised, Halstead-Reitan Trail Making Test (Part A), Corsi Block Test and Grooved Pegboard Test (favored and unfavored hand). The standard deviation (SD) for each test was computed from the preoperative scores. A participant whose postoperative performance declined by ≥1 SD as compared to each preoperative test score on ≥2 tests was classified as POCD.

    Measured: 3 months after the surgery.

  3. Postoperative delirium

    The incidence of POD was compared between the experimental group and the control group.Postoperative delirium was assessed by the Delirium Assessment Scale (CAM-ICU)

    Measured: Consecutive 7 days after the surgery

  4. Acute postoperative pain

    The incidence of acute postoperative pain was compared between the experimental group and the control group.Acute postoperative pain was assessed by Visual Analogue Scale(VAS) for 7 consecutive days within 1 week after surgery.

    Measured: Consecutive 7 days after the surgery for acute pain

  5. Chronic Postsurgical pain

    The incidence of chronic postoperative pain (CPSP) was assessed by the Short Form McGill Pain Questionnaire (SF-MPQ) and Neuropathic Pain Scale (NPS).The incidence of CPSP was compared between the experimental group and the control group.

    Measured: 3 months after the surgery for chronic pain

Secondary outcomes (4)
  1. TNF-α level in peripheral venous blood

    The incidence of TNF-α level (pg/ml) in peripheral venous blood was compared between the experimental group and the control group

    Measured: 1 day before the surgery, Postoperative day 1, 3, 5

  2. IL-6 level in peripheral venous blood

    The incidence of IL-6 level (pg/ml) in peripheral venous blood was compared between the experimental group and the control group

    Measured: 1 day before the surgery, Postoperative day 1, 3, 5

  3. IL-1β level in peripheral venous blood

    The incidence of IL-1β level (pg/ml) in peripheral venous blood was compared between the experimental group and the control group

    Measured: 1 day before the surgery, Postoperative day 1, 3, 5

  4. cortisol level in peripheral venous blood

    The incidence of cortisol level (μg/dL) in peripheral venous blood was compared between the experimental group and the control group

    Measured: 1 day before the surgery, Postoperative day 1, 3, 5

Timeline

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

  1. First posted30 Jun 2022
  2. Study start1 Oct 2022 (estimated)
  3. Primary completion1 Jul 2024 (estimated)
  4. Study completion1 Sep 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
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
600 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05439707
Sponsor's protocol ID
XuzhouCH20220620
Status last verified
Jun 2022
First submitted
20 Jun 2022
Last updated
30 Sep 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019 Apr 13;393(10180):1537-1546. doi: 10.1016/S0140-6736(19)30352-6.

    PubMed 30983589
  • Lavand'homme P. Transition from acute to chronic pain after surgery. Pain. 2017 Apr;158 Suppl 1:S50-S54. doi: 10.1097/j.pain.0000000000000809. No abstract available.

    PubMed 28134653
  • Hovens IB, Schoemaker RG, van der Zee EA, Absalom AR, Heineman E, van Leeuwen BL. Postoperative cognitive dysfunction: Involvement of neuroinflammation and neuronal functioning. Brain Behav Immun. 2014 May;38:202-10. doi: 10.1016/j.bbi.2014.02.002. Epub 2014 Feb 8.

    PubMed 24517920
  • Eckenhoff RG, Maze M, Xie Z, Culley DJ, Goodlin SJ, Zuo Z, Wei H, Whittington RA, Terrando N, Orser BA, Eckenhoff MF. Perioperative Neurocognitive Disorder: State of the Preclinical Science. Anesthesiology. 2020 Jan;132(1):55-68. doi: 10.1097/ALN.0000000000002956.

    PubMed 31834869
  • Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020 Oct;125(4):492-504. doi: 10.1016/j.bja.2020.06.063. Epub 2020 Aug 11.

    PubMed 32798069
  • Mohanty R, Lindroth H, Twadell S, Nair VA, Prabhakaran V, Sanders RD. A pilot study of neural correlates of perioperative executive function associated with noncardiac surgery in the elderly. Br J Anaesth. 2019 Nov;123(5):e517-e518. doi: 10.1016/j.bja.2019.08.001. Epub 2019 Aug 30. No abstract available.

    PubMed 31474351
  • Zhu Y, Zhou M, Jia X, Zhang W, Shi Y, Bai S, Rampes S, Vizcaychipi MP, Wu C, Wang K, Ma D, Yang Q, Wang L. Inflammation Disrupts the Brain Network of Executive Function after Cardiac Surgery. Ann Surg. 2023 Mar 1;277(3):e689-e698. doi: 10.1097/SLA.0000000000005041. Epub 2021 Jul 2.

    PubMed 34225294
  • Liu CH, Yang MH, Zhang GZ, Wang XX, Li B, Li M, Woelfer M, Walter M, Wang L. Neural networks and the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation in depression. J Neuroinflammation. 2020 Feb 12;17(1):54. doi: 10.1186/s12974-020-01732-5.

    PubMed 32050990
  • Huffman WJ, Subramaniyan S, Rodriguiz RM, Wetsel WC, Grill WM, Terrando N. Modulation of neuroinflammation and memory dysfunction using percutaneous vagus nerve stimulation in mice. Brain Stimul. 2019 Jan-Feb;12(1):19-29. doi: 10.1016/j.brs.2018.10.005. Epub 2018 Oct 9.

    PubMed 30337243
  • Redgrave J, Day D, Leung H, Laud PJ, Ali A, Lindert R, Majid A. Safety and tolerability of Transcutaneous Vagus Nerve stimulation in humans; a systematic review. Brain Stimul. 2018 Nov-Dec;11(6):1225-1238. doi: 10.1016/j.brs.2018.08.010. Epub 2018 Aug 23.

    PubMed 30217648
  • Farmer AD, Strzelczyk A, Finisguerra A, Gourine AV, Gharabaghi A, Hasan A, Burger AM, Jaramillo AM, Mertens A, Majid A, Verkuil B, Badran BW, Ventura-Bort C, Gaul C, Beste C, Warren CM, Quintana DS, Hammerer D, Freri E, Frangos E, Tobaldini E, Kaniusas E, Rosenow F, Capone F, Panetsos F, Ackland GL, Kaithwas G, O'Leary GH, Genheimer H, Jacobs HIL, Van Diest I, Schoenen J, Redgrave J, Fang J, Deuchars J, Szeles JC, Thayer JF, More K, Vonck K, Steenbergen L, Vianna LC, McTeague LM, Ludwig M, Veldhuizen MG, De Couck M, Casazza M, Keute M, Bikson M, Andreatta M, D'Agostini M, Weymar M, Betts M, Prigge M, Kaess M, Roden M, Thai M, Schuster NM, Montano N, Hansen N, Kroemer NB, Rong P, Fischer R, Howland RH, Sclocco R, Sellaro R, Garcia RG, Bauer S, Gancheva S, Stavrakis S, Kampusch S, Deuchars SA, Wehner S, Laborde S, Usichenko T, Polak T, Zaehle T, Borges U, Teckentrup V, Jandackova VK, Napadow V, Koenig J. International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Front Hum Neurosci. 2021 Mar 23;14:568051. doi: 10.3389/fnhum.2020.568051. eCollection 2020.

    PubMed 33854421

Questions about this trial

What is this clinical trial studying?

A study testing transaricular vagus nerve stimulation and fake transaricular vagus nerve stimulation in people with Postoperative Cognitive Dysfunction and Postoperative Delirium, run by Xuzhou Central Hospital at 1 site in China.

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 9 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 30 Sep 2022. 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 China. 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. Some participants in this study may receive a placebo. 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 Yangzi Zhu, Doctor (+86 18168779150, zhuyz@188.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postoperative cognitive function (time frame: 1 month after the surgery.). The study lists 5 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 NCT05439707, which also lists 11 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 30 Sep 2022.

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