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Preemptive Infiltration With Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy

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ClinicalTrials.gov Identifier: NCT04153396
Recruitment Status : Recruiting
First Posted : November 6, 2019
Last Update Posted : September 14, 2021
Sponsor:
Information provided by (Responsible Party):
Fang Luo, Beijing Tiantan Hospital

Brief Summary:
Laminoplasty and laminectomy have been used for decades for the treatment of intraspinal space occupying lesions, spinal stenosis, disc herniation, injuries, etc. After these procedures, patients often experience severe postoperative pain at the surgical site. However, current methods of pain control are mostly insufficient. At present, several pain controlling methods are available, to reduce postoperative pain after laminoplasty or laminectomy. Methods for systemic administration include: oral analgesics, intermittent intravenous, intramuscular injections, patient- controlled intravenous analgesia, etc. However, the aforementioned methods may have a lot of side effects, and are usually used after the occurrence of pain and the analgesic effects are sometimes inadequate. Topical administration options use a lower dose of drugs and therefore have less systemic side effects. Pre-emptive injection of local anesthetics can significantly reduce postoperative pain during rest and movement, however, the analgesic effect is maintained for a relatively short period of time. It is necessary to use more cases to explore the other compatibility of drugs with longer duration of action and stronger analgesic effect. Betamethasone as the stereoisomer of dexamethasone is a long-acting corticosteroid, which has long lasting anti-inflammatory properties. Whether betamethasone combined with local anesthetic for laminoplasty or laminectomy has better short-term and long-term effects than the local anesthetic alone has not been reported yet. Therefore, a prospective, randomized, controlled, blinded-endpoint study is needed to compare the postoperative analgesic efficacy of preemptive wound infilteration of ropivacaine alone and betamethasone plus ropivacaine for laminectomy or laminoplasty.

Condition or disease Intervention/treatment Phase
Pain, Postoperative Neurosurgery Drug: The Treatment group Drug: The Control group Phase 4

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 116 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Preemptive Infiltration With Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy (PRE-EASE)
Actual Study Start Date : September 1, 2021
Estimated Primary Completion Date : June 30, 2022
Estimated Study Completion Date : December 31, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: The Treatment Group
The local infiltration solution in the treatment group will consist of betamethasone and ropivacaine.
Drug: The Treatment group
The local infiltration solution in the treatment group will consist of betamethasone and ropivacaine. For local infiltration, a total of 30 ml solution will be prepared for each group, which will include 0.5ml of compound betamethasone injection(betamethasone propionate 5mg and betamethasone sodium phosphate 2mg per 1ml) added to 14.5ml of saline and 15ml of 1% ropivacaine. The surgeon will perform wound infiltration after induction of anesthesia and before surgery. A total of 10 ml of solution will be injected into each level. The study solution will be injected into the subcutaneous tissue, paravertebral muscles, along with the posterior area around the spinous process, lamina, transverse process and the facet joints, along both sides of the planned incision. The epidural space and intrathecal space will not be infiltrated.

Active Comparator: The Control group
The local infiltration solution in the control group will consist of ropivacaine.
Drug: The Control group
The local infiltration solution in the control group will consist of ropivacaine. For local infiltration, a total of 30 ml solution will be prepared for each group, which will include 15ml of ropivacaine added to 15 ml of saline for the Control group. The surgeon will perform wound infiltration after induction of anesthesia and before surgery. A total of 10 ml of solution will be injected into each level. The study solution will be injected into the subcutaneous tissue, paravertebral muscles, along with the posterior area around the spinous process, lamina, transverse process and the facet joints, along both sides of the planned incision. The epidural space and intrathecal space will not be infiltrated.




Primary Outcome Measures :
  1. The cumulative butorphanol dose during the 48 hours after surgery via the PCA device. [ Time Frame: Within 48 hours after the operation ]
    All participates will receive an electronic intravenous patient-controlled analgesia (PCA) device. Participates will be advised to push the analgesic demand button if they feel pain.


Secondary Outcome Measures :
  1. The Visual Analogue Scale (VAS) [ Time Frame: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours and 72 hours, and 1 week, 2 weeks, 4 weeks, 6 weeks and 3 months and 6 months after surgery. ]
    The pain will be assessed by the visual analogue scale (VAS) scores (0 indicates no pain, 10 indicates the most severe pain imaginable, a higher score means worse pain)

  2. The total times that participants press patient-controlled analgesia button [ Time Frame: Within 48 hours after the operation ]
    The total times that participants press patient-controlled analgesia button including effective presses and ineffective presses.

  3. The first analgesia demand on the PCA device [ Time Frame: Within 48 hours postoperatively ]
    The time from the end of the surgery to the first administration of analgesia via the PCA device

  4. Patient Satisfaction Score (PSS) [ Time Frame: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, 3 months and 6 months after surgery ]
    The Patient Satisfaction Score (PSS): 0 for unsatisfactory, and 10 for very satisfied

  5. The Postoperative Nausea and Vomiting (PONV) [ Time Frame: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery ]
    The Postoperative Nausea and Vomiting (PONV) will be measured using an ordinal scale, with 0 indicating no nausea; 1, mild nausea not requiring treatment; 2, nausea requiring treatment; 3, vomiting.

  6. Ramsay Sedation Scale (RSS) [ Time Frame: At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery ]
    The Ramsay Sedation Scale (RSS): A 6-point scale will be used to assess sedation levels, with 1 indicating agitated, anxious; 2, cooperative; 3, only responds to commands; 4, strong response to glabellar tapping or noisy stimulants; 5, weak response to glabellar tapping or noisy stimulants; 6, no response.

  7. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores [ Time Frame: At 6 months postoperatively ]
    The World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores will be used to obtain scores for four domains related to quality of life: physical health (7 items), psychological (6 items), social relationships (3items) and environment (8items). It will also include two stand-alone questions on overall quality of life and satisfaction with health. Each question will be rated on a scale of 1-5 with higher scores signifying better quality of life.

  8. The Oswestry Disability Index (ODI) [ Time Frame: Preoperatively and at 4 weeks, 6 weeks and 3 months, 6 months after surgery. ]
    Functional disability will be assessed by the Oswestry Disability Index. It includes 10 questions about pain and activities of daily living. Each item has five response categories from no pain related disability (0), to the worst possible pain disability (100). The ODI has been reported to be the most widely used and validated outcome measure in spinal surgery.

  9. Patient Scar Assessment and the Observer Scar Assessment Scale (POSAS) [ Time Frame: At 6 months postoperatively ]
    The Patient and Observer Scar Assessment Scale includes subjective symptoms of pain and pruritus and consists of 2 numerical scales: The Patient Scar Assessment Scale and the Observer Scar Assessment Scale. It assesses vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion for a scar on a score of 1 (normal skin) to 10 (worst scar imaginable). and it incorporates patient assessments of pain, itching, color, stiffness, thickness, relief and overall opinion. Participants were asked to rate the severity of their scar compared to normal skin. The overall opinion scale score ranged from 1 (normal skin) to 10 (very different from normal skin)



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Ages Eligible for Study:   18 Years to 64 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients scheduled for surgery under general anaesthesia for laminectomy or laminoplasty;
  • American Society of Anaesthesiologists (ASA) classification of I or II;
  • Age 18 to 64 years;
  • Participates with an anticipated full recovery within 2 hours postoperatively.

Exclusion Criteria:

  • Patient refusal;
  • Participants who cannot use a patient-controlled analgesia (PCA) device and cannot understand the instructions of a Visual Analogue Score (VAS);
  • Previous history of spinal surgery;
  • Allergy to opioids, betamethasone or ropivacaine;
  • Peri-incisional infection;
  • History of stroke or a major neurological deficit;
  • Trauma, deformity;
  • Psychological problems;
  • Extreme body mass index (BMI) (< 15 or > 35);
  • History of excessive alcohol or drug abuse, chronic opioid use (more than 2 weeks), or use of drugs with confirmed or suspected sedative or analgesic effects;
  • Patients using systemic steroids;
  • Pregnant or breastfeeding;
  • Preoperative Glasgow Coma Scale < 15;
  • Participants who have received radiation therapy or chemotherapy preoperatively, or with a high probability to require a postoperative radiation therapy or chemotherapy according to the preoperative imaging.
  • Not able to give written informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04153396


Contacts
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Contact: Fang Luo, M.D. +86 13611326978 13611326978@163.com
Contact: Chunmei Zhao, M.D. +86 15510286930 zhaochunmei1206@163.com

Locations
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China, Beijing
Beijing Tiantan Hospital Recruiting
Beijing, Beijing, China, 100070
Contact: Fang Luo, M.D.    +86 13611326978    13211326978@163.com   
Principal Investigator: Fang Luo, M.D.         
Sponsors and Collaborators
Beijing Tiantan Hospital
Investigators
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Principal Investigator: Fang Luo, M.D. Beijing Tiantan Hospital
Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Fang Luo, Director of Department of Pain Management, Beijing Tiantan Hospital
ClinicalTrials.gov Identifier: NCT04153396    
Other Study ID Numbers: KY 2019-112-02-1
First Posted: November 6, 2019    Key Record Dates
Last Update Posted: September 14, 2021
Last Verified: September 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Fang Luo, Beijing Tiantan Hospital:
Pain, Postoperative
Betamethasone;
Ropivacaine;
Wound Infiltration
Laminoplasty or Laminectomy
Additional relevant MeSH terms:
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Pain, Postoperative
Postoperative Complications
Pathologic Processes
Pain
Neurologic Manifestations