Postoperative Nausea and Vomiting
Conditions
Keywords
Paediatric surgery
Brief summary
Postoperative pain and nausea-vomiting (PONV) are the first causes of failure in ambulatory care in pediatric surgery. Actually, the paracetamol/ketoprofen combination in intraoperative care is recommended for effective postoperative analgesia in children. However, intravenous ketoprofen doesn't have the marketing authorization for use in children less than 15 years old and its use is mainly justified by the absence of therapeutic alternatives. Recently, findings from published studies suggest that dexamethasone (DXM), which is actually recommended to prevent PONV for children at risk, at a dose of 0.1mg/kg, would have analgesic properties above 0.15 mg/kg comparable to non-steroidal anti-inflammatories (NSAI). Main objective : To examine the effects of intraoperative DXM (0.2mg/kg and 0.4mg/kg) on the intensity of postoperative pain in the post-anaesthetic care unit (PACU) compared to ketoprofen (1mg/kg). Secondary objectives : To examine the effects of intraoperative DXM (0.2mg/kg and 0.4mg/kg) compared to ketoprofen (1mg/kg) on the anesthesia emergence delirium, the intensity of postoperative pain, the consumption of rescue analgesics and the side effects in the first 24 hours after surgery.
Detailed description
Methodology : Non inferiority, phase III, therapeutic trial. Prospective, randomized double-blinded, monocentric study. Inclusion of 567 patients. Inclusion will be performed by the anesthesiologist, the day of surgery during the preoperative visit. Each patient will be randomised to receive intraoperative DXM (0.2mg/kg), DXM (0.4mg/kg) (max 20mg) or ketoprofen (1mg/kg) (max 100mg). The clinical data will be collected prospectively in an electronic database. If the hypothesis of non-inferiority is verified, it is planned to test the superiority of the hypothesis secondarily. Treatment : Single injection of DXM (Mylan Dexamethasone® 20 mg/5 ml or 4 mg/1 ml injection ampoule solution) at 0.2 mg / kg or 0.4 mg/kg or single injection of ketoprofen (Medac ketoprofen ® 100 mg/4 ml injection ampoule solution) at 1 mg /kg after general anesthesia induction and before surgery incision.
Interventions
DRUGDexamethasone 0.2 mg/kg
Single injection of DXM (Mylan Dexamethasone® 20 mg/5 ml or 4 mg/1 ml injection ampoule solution) at 0.2 mg / kg after general anesthesia induction and before surgery incision.
DRUGDexamethasone 0.4 mg/kg
Single injection of DXM (Mylan Dexamethasone® 20 mg/5 ml or 4 mg/1 ml injection ampoule solution) at 0.4 mg / kg after general anesthesia induction and before surgery incision.
DRUGKetoprofen 1 mg/kg
Single injection of ketoprofen (Medac ketoprofen ® 100 mg/4 ml injection ampoule solution) at 1 mg /kg after general anesthesia induction and before surgery incision.
Sponsors
Rennes University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
1 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
* Children, aged 1 to 16 years * Undergoing surgery (orchiopexy, inguinal hernia, circumcision, adenoidectomy, tonsillectomy or orthopedic act with osteosynthesis) * Parental consent
Exclusion criteria
* Contraindication to NSAI or DXM * Hypersensitivity to ketoprofen, DXM, hypnovel or atarax * Porphyria * Long QT Syndrome * Renal or hepatic impairment * Corticosteroid consumption the week before surgery * NSAI consumption within 48 hours before surgery * IV induction for full stomach or myopathic patient. * French language not spoken by parents. * Simultaneous participation in biomedical research on health products
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum intensity of postoperative pain | 1 hour | Maximum intensity of postoperative pain assessed in PACU using the Faces Legs Activity Cry Consolability tool (FLACC, 0-10) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensity of postoperative pain | 24 hours | Intensity of postoperative pain assessed in ambulatory unit and at home one day after surgery. (FLACC, 0-10). |
| Rescue analgesic consumption | 24 hours | Rescue analgesic consumption in the PACU, ambulatory unit and at home. |
| Pediatric Anesthesia Emergence Delirium Scale (PAEDS) | 24 hours | Pediatric Anesthesia Emergence Delirium Scale (PAEDS) |
| Length of stay | 24 hours | Length of stay in ambulatory unit (time of possible discharge using Pediatric Post Anesthetic Discharge Scoring System and the actual time of discharge). |
| Parent's satisfaction | 24 hours | Parent's satisfaction on a four-point Likert scale |
| Side effects | 24 hours | Side effects during hospitalization (PONV, postoperative bleeding) and in the first 24 hours post-surgery (PONV, fever, bleeding, behavior modification and sleep disorders). |
Countries
France
Outcome results
None listed