Adults, Anesthesia, Postoperative Pain
Conditions
Keywords
S-ketamine,Esketamine,S (+) - ketamine, Acute Pain, Depression, Anxiety, Delirium, Hyperalgesia
Brief summary
A multicenter, randomized, open-label, active controlled pragmatic clinical trial that evaluates the safety and efficacy of S (+) -ketamine for postoperative acute pain in adults in perioperative settings.
Detailed description
Patients often suffer acute pain after operation ，which may affect the recovery. Opioid such as morphine is the most commonly analgesic drugs, but opioid has many obviously adverse reactions ,for example respiratory depression,circulation inhibition,tolerance, addiction, nausea, vomiting, pruritus, etc. S (+) - ketamine has been described to decrease acute pain and opioid consumption,but it needs to confirm for chinese patients undergoing surgery. Objective:Evaluate the efficacy and safety of S (+) - ketamine on acute perioperative pain for chinese adult patients,and look for the best dosage, mode of administration, timing, and compatibility ,as well explore the effect of S (+) - ketamine on postoperative delirium,anxiety ,depression and cognitive dysfunction.
Interventions
Patients who undergo general anesthesia using S(+)-ketamine hydrochloride for anesthesia induction,maintenance or postoperative analgesia.
DRUGConventional therapy
Receiving conventional therapy without S (+)-Ketamine hydrochloride injection. There is no restrictions in drugs, doses and incompatibility, the researchers can choose appropriate medication regimens based on clinical practice, but other NMDA receptor antagonists are not be allowed to use, such as dextromethorphan and amantadine.
Sponsors
Jiangsu Provincial People's Hospital
Beijing Hospital
The Affiliated Hospital of Qingdao University
Renmin Hospital of Wuhan University
First Affiliated Hospital Xi'an Jiaotong University
First Affiliated Hospital, Sun Yat-Sen University
Shengjing Hospital
Southern Medical University, China
Chinese PLA General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Experimental group : Control group=2:1
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 1\. Age ≥18 years old; * 2\. Scheduled for elective digestive tract surgery, gynecological surgery, urological surgery, thoracic surgery, orthopedic limb surgery, orthopedic spine surgery or body surface surgery (thyroid surgery or breast surgery), head and neck surgery; * 3\. ASA score Ⅰ～Ⅲ; * 4\. The informed consent form was signed by the patients.
Exclusion criteria
* 1\. The expected length of hospital stay of the patient is less than 48h; * 2\. Patients expected to be admitted to the ICU after surgery; * 3\. Patients expected to return to the ward with tracheal catheter after surgery; * 4\. Be allergic to S (+) - ketamine; * 5\. Patients with severe disorder of consciousness or mental system diseases (schizophrenia, mania, bipolar disorder, psychosis, etc.) or cognitive dysfunction; * 6\. Patients with a history of severe cardiovascular disease (congestive heart failure, severe angina attack, or unstable angina or myocardial infarction within 6 months); * 7\. Patients during pregnancy or lactation; * 8\. Patients with MMSE score \<18 points; * 9\. Patients with any of the following contraindications of S (+) - ketamine: 1. Patients with risk of serious rise of blood pressure or intracranial pressure; 2. Patients with high intraocular pressure (glaucoma) or penetrating ocular trauma; 3. Patients with poorly controlled or untreated hypertension (Resting systolic blood pressure greater than 180 mmHg, or resting diastolic blood pressure greater than 100mmHg); 4. Patients with untreated or undertreated hyperthyroidism.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The area under the broken line of NRS score | Hour 0-48 after surgery | The score of Numerical Rating Scale(NRS) is 0-10, the higher the score, the more severe the pain. |
| Opioid consumption | Hour 0-48 after surgery | Total opioid consumption(conversion to equivalent morphine) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of rescue analgesia | Hour 0-48 after surgery | The incidence of rescue analgesia within 48h after surgery |
| Recovery time | Day 0 | The time from the end of the operation to recovery(can be awakened) |
| The incidence of unexpected intraoperative events | Intraoperative | Unexpected events during operation include intraoperative cough, laryngeal spasm, body movement, tachycardia,decreased oxygen saturation, respiratory depression, bradycardia, hypertension and hypotension. |
| The Patient Efficacy Questionnaire (IPOQ ) scores | Hour 48 after surgery | Patient Efficacy Questionnaire (IPOQ ) scale include 13 questions , each question's score is 0-10 or 0-100%, it involves postoperative pain, mood and quality of life. The higher the score, the more severe the pain symptoms. |
| NRS pain scores | Hour 0-48 after surgery | The score of Numerical Rating Scale(NRS) is 0-10, the higher the score, the more severe the pain. |
| Pharmacoeconomic indicators | Hour 48 after surgery | Calculating incremental cost-effectiveness ratio （ICER）based on cost-effectiveness analysis. |
| Incidence of postoperative delirium | Hour 0-48 after surgery | The Chinese version of the 3D-CAM scale is used for the diagnosis of delirium, and the assessment will be carried out at 24h, 48h and 72h after the operation. If the patient is discharged 72h after the patient is discharged, it may not be assessed. |
| Simple Mental State Examination (MMSE) Scale score | Hour 48 after surgery | The total score of Simple Mental State Examination Scale (MMSE) is 30,the higher the score, the better the cognitive function. |
| Hospital Anxiety and Depression (HAD) Scale score | Hour 48 after surgery | Hospital Anxiety and Depression Scale (HAD) includes anxiety measure(7questions,0-21pionts) and depression measure(7 questions,0-21pionts),the higher the score, the more severe thesymptoms. |
| The incidence of adverse events after surgery | Hour 0-48 after surgery | The incidence of adverse events from the end of the operation to 48h after surgery. Including nausea, vomiting, increased secretions, dizziness, oversedation, infection,anesthetic awareness, nightmares, restlessness, pruritus, disorientation, delirium, respiratory depression, diplopia, diarrhea, intestinal obstruction, urinary retention, gastroesophageal reflux, constipation, chills, hallucinations, etc. |
| Time of first rescue analgesia | Hour 0-48 after surgery | The time from the end of the operation to the first rescue analgesics after the operation. Rescue analgesia refers to the analgesia according to the patient's requirements in addition to routine postoperative analgesia. |
Contacts
Primary ContactWeidong Mi, MD
Backup ContactHong Wang, MD
Outcome results
None listed