Adenotonsillectomy
Conditions
Keywords
pain, opioid-free recovery, Suprazygomatic maxillary nerve block
Brief summary
The goal of this clinic trial is to evaluate the impact of dexmedetomidine as an adjunct pain pain medication on opioid-free recovery in children undergoing adenotonsillectomy with Suprazygomatic maxillary nerve block (SZMB). The main questions it aims to answer are: * Does SZMB with the local anesthetic ropivacaine and the adjuvant dexmedetomidine result in less pain * Is dexmedetomidine associated with an improved quality of recovery at home Researchers will compare pain in participants given an SZMB with ropivacaine and an adjuvant dexmedetomidine, participants given SZMB with ropivacaine only, and a SZMB with ropivacaine and dexmedetomidine given intravenously. Participants will: * Be given the SZMB during the surgery. * Be evaluated after surgery to measure their opioid consumption, pain severity, level of agitation, and level of delirium * Complete a daily questionnaire for 7 days after surgery on the patients pain and recovery
Interventions
PROCEDURERopivacaine
Administration of ropivacaine in a Suprazygomatic maxillary nerve block
Sponsors
McGill University Health Centre/Research Institute of the McGill University Health Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
2 Years to 7 Years
Healthy volunteers
No
Inclusion criteria
* Scheduled for elective partial adenotonsillectomy, * STUBR score ≥ 3, indicating significant sleep-disordered breathing * Patients whose parents are fluent in French of English will be enrolled
Exclusion criteria
* Scheduled to undergo total extracapsular adenotonsillectomy or adenoidectomy-only procedures * Patient requires prolonged intubation postoperatively * the anesthesiologist does not adhere to the standardized anesthesia protocol * Patients with neurological or cardiac congenital deficits, with cardiac arrhythmias (non-sinus rhythm), implanted pacemakers, on chronic therapy with drugs that have known effects on sympathetic and parasympathetic activity (antimuscarinics, beta-2 adrenergic agonists, alpha-1 adrenergic antagonists or antiarrhythmic agents, tricyclic antidepressants) * ASA physical status III or higher * Parent/legal guardians refuses to participate * Patients scheduled for surgery without an appointment at the Montreal Children's Hospital (MCH) Preoperative Clinic will not be enrolled in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opioid-free recovery | 2 hours | Incidence of patients not requiring opioids in the PACU after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with postoperative Pain | 2 hours | Patients were classified as having pain if they had a Face, Activity, Cry, Consolability (FLACC) score that was greater than or equal to 3. |
| Number of Patients with Emergence Delirium | 2 hours | Patients were classified as having emergence delirium if they had a score on the emergence delirium scale that was greater than or equal to 10 in the Post-anesthesia care unit. |
| Pain through follow-up | 7 days | Difference in pain between the groups, assessed with the Parents' Postoperative Pain Measure |
| Quality of Recovery through follow-up | 7 days | Differences in the Quality of recovery between the groups, as measured by the Post-Hospitalization Behavior Questionnaire for Ambulatory Surgery. |
Countries
Canada
Contacts
Primary ContactGianluca Bertolizio, MD, FRCPC
Outcome results
None listed