None listed
Conditions
Brief summary
Obstructive sleep apnoea is a common problem. During sleep, some of us have occasional blockade of our breathing passage. This condition disturbs our sleep and makes us feel sleepy during the day. People with sleep apnoea are at higher risk of breathing problems and low oxygen level after surgery, compared to those without. The use of sedative pain medications may make this worse. Study hypothesis: By using nerve block anaesthesia to control post-operative pain in patients at high risk of obstructive sleep apnoea, the use of sedative pain medications may be lower and the oxygen level may be better. Study method: All patients scheduled for orthopaedic surgeries will be interviewed by the anaesthetic doctors before the surgery. If they are at high risk of obstructive sleep apnoea, the doctor will invite them to participate in this study. Patients who agree to participate will be randomly assigned to the conventional arm or interventional arm. A small machine will be strapped on their wrist, like a wrist watch, to monitor the oxygen level when they sleep. This is started on the night before the surgery and 3 nights after. Patients in the interventional arm receive a nerve block anaesthesia before the surgery. For both arms, general anaesthesia will be performed. Adequate pain relief will be given during and after the surgery. Patients will receive pain medications in the form of pills and from a machine that they control themselves. All patients receive oxygen for at least 24 hours. The anaesthetic doctor perform daily visit to monitor patients' condition. Besides comparing the oxygen level, other aspects of post-operative care will also be monitored, including the morphine usage, pain score, sedation score and length of hospital stay.
Interventions
Orthopaedic surgical patients who scored 5 or above in the STOP-BANG questionnaire will be recruited. They will be randomised into 2 arms.
Arm 1: conventional arm. Post-operative pain is managed using patient-controlled morphine and other non-opioid analgesics.
Arm 2: interventional arm. Post-operative pain is managed using peripheral nerve blocks, patient-controlled morphine and other non-opioid analgesics.
All peripheral nerve blocks will be administered by anaesthetists or anaesthetic traine
Orthopaedic surgical patients who scored 5 or above in the STOP-BANG questionnaire will be recruited. They will be randomised into 2 arms. Arm 1: conventional arm. Post-operative pain is managed using patient-controlled morphine and other non-opioid analgesics. Arm 2: interventional arm. Post-operative pain is managed using peripheral nerve blocks, patient-controlled morphine and other non-opioid analgesics. All peripheral nerve blocks will be administered by anaesthetists or anaesthetic trainee with more than 5 years' experience. The blocks will be performed in the operating theatre under ultrasound guidance, before the induction of general anaesthesia. The type of block administered depends on the type of orthopaedic surgery planned. The total dose of local anaesthetic will not exceed the recommended dose calculated from the patient's body weight (ropivacaine 3mg/kg or levo-bupivacaine 2mg/kg). The choice between ropivacaine or levo-bupivacaine depends on the anaesthetists' preference and availability of the drug. Post-operatively all patients will receive oxygen supplement for 24 hours (facemask 5L/min in the recovery zone & nasal prong 3L/min in the ward). Unless contraindicated, all patients will be prescribed oral paracetamol 1g 6-hourly and oral celecoxib 200mg 12-hourly for 5 days in addition to the patient-controlled morphine. The patient-controlled morphine uses our standard hospital protocol (1mg per bolus of intravenous morphine, lock-out time of 5 minutes, maximum dose of 48mg per 4 hours, duration 1-3 days depending on patient's clinical condition). The oxygen desaturation index (for both Arms) will be monitored for 3 consecutive nights. In addition, patients' morphine usage, pain score, sedation score, and length of hospital stay will be recorded.
Sponsors
Lai Hou Yee
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria 1) Aged 18 years old and above 2) STOPBANG score of 5 or more. 3) American Society of Anesthesiologist ASA 1 or 2 4) Patient is scheduled for a surgical procedure that is expected to: -Undergo general anesthesia -Post-operative analgesia can be achieved completely by regional nerve blocks. -Remain hospitalized for at least 48 hours postoperatively 5) Orthopaedic surgery involving the upper limb (below shoulder) or lower limb (knee and below)[type of surgery that included]
Exclusion criteria
Exclusion criteria 1) Pregnant 2) ASA 3 and above 3) Patients who require post-operative ventilation 4) Diagnosed to have OSA and on night CPAP therapy 5) Contraindicated for peripheral nerve block (such as coagulopathy, allergic to local anaesthetics, and patient refusal) 6) Underlying irreversible respiratory disease 7) Postoperative analgesia of the procedure that cannot be achieved with up to two peripheral nerve blocks. 8) Require surgery in other part of the body
Outcome results
None listed