Pain Clinical Trial
Official title:
The Effects and Dose Response of Dexamethasone on Intercostal Nerve Blocks With Bupivicaine in Post Thoracic Surgery Patients
Post-op analgesia is the most important part of early and safe patient recovery in thoracic
surgery. This is for both humane and patient outcome reasons. Patient outcomes are greatly
improved with optimal pain control and complications and length of stay are minimized. Most
post-op thoracic complications are from decreased respiratory effort, failure to clear
secretions and pulmonary infections from retained sputum with subsequent sequelae. Good
post-operative analgesia not only prevents these complications but also considerably
enhances early mobilization and thus, decreased hospital stay and efficient resource
allocation. Early post-operative pain is also associated with late and chronic post
thoracotomy pain syndromes which can be debilitating.
Pain following thoracic surgery is different to the standard surgical incision pain and is
due to intercostal nerve damage, compression or traction injury to the nerve. This occurs
with the incision, rib retraction, and is compounded by the on-going need for respiratory
effort. The approach to managing this pain is multi-modal analgesia. The standard regimen
stretches from preemptive analgesia and preoperative placement of thoracic epidurals to
post-op opioid infusions. However, non-invasive pharmacology includes paracetamol, non
steroidal anti inflammatory drugs (NSAIDs), mild and moderate opioids as well as
anti-convulsants like pregabalin. However, opioid use has well-known side effects including
central nervous system (CNS) and respiratory depression which unfortunately delay mobility
and recovery. This has motivated opioid-sparing strategies.
The investigators study aims to assess whether the addition of perineural dexamethasone (a
steroid) to the current practice of local anaesthetic wound catheters increases the efficacy
and duration of analgesia provided.
Recent years have seen the importance of early mobility and respiratory toilet to minimise
complications and hospital stay. Newer methods of pain relief with fewer systemic effects
have become even more important. Continuous wound infiltration catheters (CWI's) aim to
deliver local anaesthetic agents directly into the wound (4). This technique goes back to
1994, and has been established in this hospital and is used in a non-structured manner in
thoracic surgery. Recent studies have demonstrated that the addition of dexamethasone (a
steroid) to local anaesthetic agents in similar nerve blocks significantly improves the
analgesic affect and prolongs the duration of the analgesia. To the best of the
investigators knowledge this has not been tested in a thoracic surgery cohort of patients,
though it has been tested safely and effectively in the thorax in healthy volunteers and in
postoperative analgesia in abdominal and musculoskeletal post op patients. The investigators
aim is to assess whether the addition of perineural dexamethasone to the local anaesthetic
in CWI's is superior to the local anaesthetic alone in thoracic post operative patients, and
at which dose. They also want to assess the levels of pain experienced 1 month post op to
evaluate the potential effect of dexamethasone on post thoracoscopy pain syndrome.
The investigators aim is to compare the use of local anaesthetic agent in combination with
perineural dexamethasone with the current practice of local anaesthetic alone at relieving
pain in the immediate post op pain period. The investigators also want to assess whether the
8mg dose of dexamethasone used in similar studies is the optimal dose or whether a similar
effect can be observed at a smaller dose of 4mg.
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Active, not recruiting |
NCT05559255 -
Changes in Pain, Spasticity, and Quality of Life After Use of Counterstrain Treatment in Individuals With SCI
|
N/A | |
Terminated |
NCT04356352 -
Lidocaine, Esmolol, or Placebo to Relieve IV Propofol Pain
|
Phase 2/Phase 3 | |
Completed |
NCT04748367 -
Leveraging on Immersive Virtual Reality to Reduce Pain and Anxiety in Children During Immunization in Primary Care
|
N/A | |
Completed |
NCT05057988 -
Virtual Empowered Relief for Chronic Pain
|
N/A | |
Completed |
NCT04466111 -
Observational, Post Market Study in Treating Chronic Upper Extremity Limb Pain
|
||
Recruiting |
NCT06206252 -
Can Medical Cannabis Affect Opioid Use?
|
||
Completed |
NCT05868122 -
A Study to Evaluate a Fixed Combination of Acetaminophen/Naproxen Sodium in Acute Postoperative Pain Following Bunionectomy
|
Phase 3 | |
Active, not recruiting |
NCT05006976 -
A Naturalistic Trial of Nudging Clinicians in the Norwegian Sickness Absence Clinic. The NSAC Nudge Study
|
N/A | |
Completed |
NCT03273114 -
Cognitive Functional Therapy (CFT) Compared With Core Training Exercise and Manual Therapy (CORE-MT) in Patients With Chronic Low Back Pain
|
N/A | |
Enrolling by invitation |
NCT06087432 -
Is PNF Application Effective on Temporomandibular Dysfunction
|
N/A | |
Completed |
NCT05508594 -
Efficacy and Pharmacokinetic-Pharmacodynamic Relationship of Intranasally Administered Sufentanil, Ketamine, and CT001
|
Phase 2/Phase 3 | |
Recruiting |
NCT03646955 -
Partial Breast Versus no Irradiation for Women With Early Breast Cancer
|
N/A | |
Active, not recruiting |
NCT03472300 -
Prevalence of Self-disclosed Knee Trouble and Use of Treatments Among Elderly Individuals
|
||
Completed |
NCT03678168 -
A Comparison Between Conventional Throat Packs and Pharyngeal Placement of Tampons in Rhinology Surgeries
|
N/A | |
Completed |
NCT03931772 -
Online Automated Self-Hypnosis Program
|
N/A | |
Completed |
NCT03286543 -
Electrical Stimulation for the Treatment of Pain Following Total Knee Arthroplasty Using the SPRINT Beta System
|
N/A | |
Completed |
NCT02913027 -
Can We Improve the Comfort of Pelvic Exams?
|
N/A | |
Terminated |
NCT02181387 -
Acetaminophen Use in Labor - Does Use of Acetaminophen Reduce Neuraxial Analgesic Drug Requirement During Labor?
|
Phase 4 | |
Recruiting |
NCT06032559 -
Implementation and Effectiveness of Mindfulness Oriented Recovery Enhancement as an Adjunct to Methadone Treatment
|
Phase 3 | |
Active, not recruiting |
NCT03613155 -
Assessment of Anxiety in Patients Treated by SMUR Toulouse and Receiving MEOPA as Part of Their Care
|