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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04530903
Other study ID # B076202042809
Secondary ID
Status Recruiting
Phase Phase 4
First received
Last updated
Start date September 9, 2020
Est. completion date January 1, 2021

Study information

Verified date September 2020
Source Centre Hospitalier Universitaire Saint Pierre
Contact Panayota Kapessidou, MD,PhD
Phone +32.2.535
Email pkapessi@ulb.ac.be
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Proctological surgery represents a short duration surgery performed in ambulatory, which causes significant post-operative pain.

Post-operative pain resulting from proctological surgery is greater than 5 on the Visual Analog Scale (VAS) within the first 24 hours and it revives during the first defecation.

The ideal pain management procedures are based on the multimodal analgesia model, based in turn on the combination of products and / or techniques to improve the quality of analgesia, reduce the side effects linked to the use of opioids, reduce responses to surgical stress, reduce postoperative recovery and allow rapid rehabilitation of the patient.

The aim of our study is to investigate whether clonidine combined with levobupivacaine in the pudendal block reduce the total consumption of opioids in proctological surgery.


Recruitment information / eligibility

Status Recruiting
Enrollment 30
Est. completion date January 1, 2021
Est. primary completion date January 1, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Age = 18 years

- Signature of informed consent

Exclusion Criteria:

- Refusal to participate ;

- Allergy to either local anaesthetics or clonidine;

- Local infectious pathologies (e.g. acute ano-perineal suppuration)

- Pregnancy

- Breastfeeding

- Severe bradyarrhythmia due to sinus node disease or second and third degree atrioventricular block

- Severe depressive condition

- Severe coronary artery disease

- Raynaud's disease

- Heart failure

- Obliterating thromboangiitis

- Epilepsy

- Spinal anesthesia

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Clonidine
75 µg (0.5mL) per injection site
Levobupivacaine
0.25% (10 ml) per injection site
NaCl 0.9%
Nacl 0.9% (0.5ml) per injection site

Locations

Country Name City State
Belgium University Hospital Saint-Pierre Brussels

Sponsors (1)

Lead Sponsor Collaborator
Centre Hospitalier Universitaire Saint Pierre

Country where clinical trial is conducted

Belgium, 

References & Publications (19)

Bernard JM, Macaire P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology. 1997 Aug;87(2):277-84. — View Citation

Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 2011 Fall;49(4):104-16. doi: 10.1097/AIA.0b013e31820e4a49. Review. — View Citation

Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999 Jul;91(1):8-15. — View Citation

Ceulemans A, De Looze D, Van de Putte D, Stiers E, Coppens M. High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study. Acta Chir Belg. 2019 Aug;119(4):224-230. doi: 10.1080/00015458.2018.1500802. Epub 2018 Sep 7. — View Citation

Comité douleur-anesthésie locorégionale et le comité des référentiels de la Sfar. [Formalized recommendations of experts 2008. Management of postoperative pain in adults and children]. Ann Fr Anesth Reanim. 2008 Dec;27(12):1035-41. doi: 10.1016/j.annfar.2008.10.002. Epub 2008 Nov 21. French. — View Citation

De La Arena P.. Bloc pudendal sous e´chographie: faisabilite´ et efficacite´ perope´ratoire chez l'enfant. Annales Franc¸aises d'Anesthe´sie et de Re´animation 2014; A398-A403.

Gaudet-Ferrand I, De La Arena P, Bringuier S, Raux O, Hertz L, Kalfa N, Sola C, Dadure C. Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach. Paediatr Anaesth. 2018 Jan;28(1):53-58. doi: 10.1111/pan.13286. Epub 2017 Dec 5. — View Citation

Imbelloni LE, Vieira EM, Gouveia MA, Netinho JG, Spirandelli LD, Cordeiro JA. Pudendal block with bupivacaine for postoperative pain relief. Dis Colon Rectum. 2007 Oct;50(10):1656-61. — View Citation

Joshi GP, Neugebauer EA; PROSPECT Collaboration. Evidence-based management of pain after haemorrhoidectomy surgery. Br J Surg. 2010 Aug;97(8):1155-68. doi: 10.1002/bjs.7161. Review. — View Citation

Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North Am. 2005 Mar;23(1):185-202. Review. — View Citation

Kelika P, Arun JM. Evaluation of clonidine as an adjuvant to brachial plexus block and its comparison with tramadol. J Anaesthesiol Clin Pharmacol. 2017 Apr-Jun;33(2):197-202. doi: 10.4103/joacp.JOACP_58_13. — View Citation

Kirksey MA, Haskins SC, Cheng J, Liu SS. Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One. 2015 Sep 10;10(9):e0137312. doi: 10.1371/journal.pone.0137312. eCollection 2015. — View Citation

Li A, Wei Z, Liu Y, Shi J, Ding H, Tang H, Zheng P, Gao Y, Feng S. Ropivacaine versus levobupivacaine in peripheral nerve block: A PRISMA-compliant meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Apr;96(14):e6551. doi: 10.1097/MD.0000000000006551. — View Citation

Malav K, Singariya G, Mohammed S, Kamal M, Sangwan P, Paliwal B. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery. Turk J Anaesthesiol Reanim. 2018 Feb;46(1):15-20. doi: 10.5152/TJAR.2017.03411. Epub 2017 Nov 27. — View Citation

McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 2007 Jul-Aug;32(4):330-8. Review. — View Citation

Naja Z, Ziade MF, Lönnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain. Can J Anaesth. 2005 Jan;52(1):62-8. — View Citation

Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD009200. doi: 10.1002/14651858.CD009200.pub2. Review. — View Citation

Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 2009 Aug;111(2):406-15. doi: 10.1097/ALN.0b013e3181aae897. Review. — View Citation

Vinson-Bonnet B.. Le bloc pudendal: technique d'analgésie postopératoire en chirurgie proctologique. Pelvi-Périnéologie 2007, 2(2):180-183.

* Note: There are 19 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Total Dose of Opioids consumed in the intraoperative period Total consumption of sufentanyl during the intraoperative period (in micrograms). The administration of sufentanyl depends on the change of physiological parameters (augmentation of 20% of blood pressure and/or cardiac frequency). up to 24 hours post-surgery
Secondary Total Dose of tramadol consumed in the recovery room In the recovery room, dose of tramadol (in milligrams, intravenous administration). The administration of tramadol depends on Visual Analogic Pain Score (VAS>4) (scale = 0 no pain; 10 = worst pain imaginable) up to 24 hours post-surgery
Secondary Total consumption of tramadol in post-operative period Total consumption of tramadol from the exit of the recovery room to the day after the surgery based on Visual Analogic Pain Score >4 (scale = 0 no pain; 10 = worst pain imaginable).
Tramadol (dose in milligrams, oral administration)
up to 24 hours post-surgery
Secondary Need for tramadol administration per patient during the first 24 hours Number of Tramadol dose requested by the patient during the first 24 hours up to 24 hours post-surgery
Secondary Total Dose of piritramide consumed in the recovery room In the recovery room, dose of piritramide (in milligrams, intravenous administration). The administration of piritramide depends on Visual Analogic Pain Score (VAS>4) (scale = 0 no pain; 10 = worst pain imaginable) up to 24 hours post-surgery
Secondary Need for Piritramid administration per patient during the hospitalization in Post Anesthesia Care Unit (PACU) Number of Piritramid dose requested by the patient during the hospitalization in Post Anesthesia Care Unit (PACU) during the hospitalization in Post Anesthesia Care Unit (PACU)
Secondary Total consumption of paracetamol in post-operative period Total consumption of paracetamol from the exit of the recovery room to the day after the surgery based on Visual Analogic Pain Score >4 (scale = 0 no pain; 10 = worst pain imaginable). Paracetamol (dose in grams, oral administration) up to 24 hours post-surgery
Secondary Total consumption of diclofenac in post-operative period Total consumption of diclofenac from the exit of the recovery room to the day after the surgery based on Visual Analogic Pain Score >4 (scale = 0 no pain; 10 = worst pain imaginable).
Diclofenac (dose in milligrams, oral administration)
up to 24 hours post-surgery
Secondary Time before First Use of Rescue Analgesic Time between the completion of the block and the first post-operative administration of rescue analgesics (Tramadol and/or Piritramide on request) up to 24 hours post-surgery
Secondary Post-operative Pain as assessed by Visual Analog Scale Post-operative Pain levels will be determined every 15 minutes in the recovery room, then every hour until discharge and on Day 1 at home; Visual Analog pain score (scale = 0 no pain; 10= worst pain imaginable) up to 24 hours post-surgery
Secondary Patient satisfaction Level of satisfaction assessed on a 5-point scale (from 1 to 5): 1 not satisfied, 2 not very satisfied, 3 moderately satisfied, 4 satisfied, 5 very satisfied. up to 24 hours post-surgery