Clinical Trial Details
— Status: Withdrawn
Administrative data
NCT number |
NCT04600427 |
Other study ID # |
12731 |
Secondary ID |
|
Status |
Withdrawn |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
September 1, 2021 |
Est. completion date |
August 31, 2023 |
Study information
Verified date |
September 2021 |
Source |
McMaster University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Epidural anesthesia may represent a safe and effective pharmacological tool in the management
of Ogilvie's Syndrome. This pilot study aims to demonstrate feasibility, safety, and efficacy
of epidural anesthesia to set the stage for adequately powered future randomized controlled
trials (RCTs) in order to assess the efficacy of epidural anesthetic as a pharmacological
treatment strategy for Ogilvie's Syndrome. Ultimately, this research may prompt further
investigation and establish standardized criteria for managing Ogilvie's Syndrome patients
with epidural anesthesia.
Description:
Currently, treatment pathways for Ogilvie's Syndrome suggest observation and attempted
correction of the potential precipitating factors for 24 to 72 hours following radiologic
assessment if the cecum is less than 12cm and abdominal imaging does not demonstrate signs of
impending perforation. Should symptoms fail to resolve beyond 72 hours, and the cecum remain
under 12cm without worsening clinical status, pharmacologic intervention with neostigmine is
indicated. Symptoms resolve in 60% to 90% of patients following administration of single dose
of neostigmine, however continued monitoring is required as up to 40% of these patients can
experience recurrent colonic dilation. Additionally, neostigmine can be associated with
serious adverse events such as bradycardia and bronchospasm. Altogether, there may be
potential for further optimization of the pharmacologic management of Ogilvie's Syndrome.
Given the predominant theory that Ogilvie's Syndrome is caused by sympathetic overdrive, the
splanchnic sympathetic blockade provided by epidural anesthesia could be of theoretical
benefit. In 1988, a small, prospective cohort study evaluated the use of epidural anesthesia
in eight patients with Ogilvie's Syndrome. Symptoms were controlled and cecal dilation
resolved without recurrence in 62.5% of these patients, and the authors concluded that with
further study, the use of epidural anesthesia could be a reasonable alternative to
neostigmine. Yet, no subsequent studies were performed.
This proposed single-arm, single-center prospective cohort pilot study will examine the
feasibility, safety, and efficacy of epidural anesthesia in patients with Ogilvie's Syndrome
refractory to conservative management. Adult patients with a documented diagnosis of
Ogilvie's Syndrome admitted as an inpatient to St. Joseph's Healthcare Hamilton (SJHH) who
failed conservative management will be included. Following assessment of eligibility and the
informed consent process, patients will be evaluated by the acute pain service
anesthesiologist. A low-dose bupivacaine (0.25%) infusion will commence following insertion
of an epidural catheter at the T11-12 interspace, with a loading dose of 5-10mL followed by a
3mL per hour infusion. Monitoring for resolution of disease will take place iteratively by
the general surgery team, and failed symptom resolution will mandate further treatment in the
form of colonoscopic decompression or surgical intervention. Patients will be followed
throughout their index hospital and stay and up to 30 days following discharge from hospital.
Feasibility will be assessed through recruitment rate and rate of successful epidural
placement. The rate of epidural anesthesia-related morbidity within 30 days of treatment will
serve as the primary safety measure. The primary efficacy measure is clinical and radiologic
resolution without recurrence.