Postoperative Pain Clinical Trial
Official title:
Catheter-based Peripheral Regional Anesthesia After Orthopedic Surgery to the Foot or Ankle: Comparison of Low Dose, Automated Periodic Infusions With Conventional High Dose, Continuous Infusion, and Patient-initiated Infusions Only
BACKGROUND
Orthopedic surgery can be severely painful, and peripheral regional anesthesia is highly
recommended as part of the perioperative pain treatment. Whether catheter-based techniques
are better than single injection techniques are debatable. Furthermore, in catheter-based
techniques, whether a low-dose automated, periodic infusion can produce similar analgesic
effectiveness compared to a conventional, high dose, continuous infusion has never been
explored.
AIM
Comparison of the analgesic effectiveness of a low-dose automated, periodic infusion, a
conventional continuous infusion and patient-controlled boluses only in catheter-based nerve
blocks for patients undergoing orthopedic surgery to the foot or ankle.
BACKGROUND
Orthopedic surgery has been reported to be moderate to severely painful in approximately 50 %
of patients.
Peripheral regional anesthesia (PRA) using single injection nerve blocks is highly
recommended as part of a multimodal, perioperative, analgesic treatment. Patients who are
expected to have postoperative, severe pain exceeding the duration of a single injection
nerve block may benefit from a catheter-based nerve block (CBNB) using either a continuous
infusion (CI) or intermittent infusions of local anesthetics (LA). Intermittent boluses can
be either patient-controlled or prescribed in combination with a continuous infusion or as
prespecified intermittent boluses. Whether a CBNB treatment is superior to a single injection
nerve block after orthopedic surgery remains unanswered.
There are several challenges when using a CBNB treatment: The dosing or delivery method may
be either insufficient and thus not pain relieving or too powerful resulting in dense motor
block and limb anesthesia which may compromise safety and rehabilitation. The peripheral
nerve block catheter may also displace and therefore deposit LA too far from the targeted
nerve(s) to produce an effective nerve block.
Previous studies suggest that an automated periodic infusion (API) regimen is superior to CI.
It seems that an API produces better pain control, a lower analgesic consumption over time
and less motor inhibition. This is well-described for epidural catheters for laboring women,
but evidence is also apparent in PRA. Adding a PCA bolus option to a catheter-based nerve
block treatment may even out the difference in pain scores between API and CI. However, it
seems that API groups require less LA via PCA function. Reducing LA consumption is of great
importance for ambulatory patients whose LA reservoir is limited, but also for all other
orthopedic patients whose motor block should be minimized in order to optimize
rehabilitation.
OBJECTIVES
To investigate whether a low-dose API with patient-controlled bolus option can produce a
similar analgesic effect compared to a conventional, high dose, CI with patient-controlled
bolus option in catheter-based peripheral nerve blocks for patients undergoing orthopedic
surgery to the foot or ankle. Analgesic effectiveness will be compared with a group only
given the patient-controlled bolus option.
HYPOTHESIS
Low dose API with supplemental patient-controlled bolus option will provide pain-relieving
therapy not inferior to a conventional CI with supplemental patient-controlled bolus option.
The intervention group receiving patient-controlled boluses only will experience more pain
breakthrough.
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT04633850 -
Implementation of Adjuvants in Intercostal Nerve Blockades for Thoracoscopic Surgery in Pulmonary Cancer Patients
|
||
Recruiting |
NCT03181620 -
Sedation Administration Timing: Intermittent Dosing Reduces Time to Extubation
|
N/A | |
Completed |
NCT04579354 -
Virtual Reality (VR) Tour to Reduce Preoperative Anxiety Before Anaesthesia
|
N/A | |
Recruiting |
NCT06007378 -
Optimizing Postoperative Pain Control After Laparoscopic Colorectal Surgery
|
N/A | |
Recruiting |
NCT05943015 -
Analgesic Efficacy of Quadratus Lumborum, Paravertebral Blocks
|
N/A | |
Completed |
NCT04544228 -
Ketamine or Neostigmine for Serratus Anterior Plane Block in Modified Radical Mastectomy
|
N/A | |
Completed |
NCT03678168 -
A Comparison Between Conventional Throat Packs and Pharyngeal Placement of Tampons in Rhinology Surgeries
|
N/A | |
Completed |
NCT03286543 -
Electrical Stimulation for the Treatment of Pain Following Total Knee Arthroplasty Using the SPRINT Beta System
|
N/A | |
Completed |
NCT03663478 -
Continuous TQL Block for Elective Cesarean Section
|
Phase 4 | |
Completed |
NCT04176822 -
Designing Animated Movie for Preoperative Period
|
N/A | |
Completed |
NCT05170477 -
Influence of Apical Patency Concept Upon Postoperative Pain After Root Canal Treatment
|
N/A | |
Not yet recruiting |
NCT04561856 -
Fascia Iliaca Block Supplemented With Perineural Vs Intravenous Dexamethasone
|
Phase 4 | |
Completed |
NCT03612947 -
TAP Block in Laparoscopic Cholecystectomy.
|
Phase 2 | |
Recruiting |
NCT05974501 -
Pre vs Post Block in Total Knee Arthroplasty (TKA)
|
Phase 4 | |
Completed |
NCT05995912 -
Efficacy and Safety of Etoricoxib-tramadol Tablet in Acute Postoperative Pain
|
Phase 2 | |
Completed |
NCT04571515 -
Dose-Response Study of MR-107A-01 in The Treatment of Post-Surgical Dental Pain
|
Phase 2 | |
Active, not recruiting |
NCT04190355 -
The Effect of Irrigant Types Used During Endodontic Treatment on Postoperative Pain
|
N/A | |
Recruiting |
NCT05145153 -
Incidence of Chronic Pain After Thoracic Surgery
|
||
Recruiting |
NCT03697278 -
Monitoring Postoperative Patient-controlled Analgesia (PCA)
|
N/A | |
Completed |
NCT03650998 -
Transmuscular Quadratus Lumborum Block for Total Laparoscopic Hysterectomy.
|
Phase 4 |