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Effect of Dexmedetomidine Combined With Low-dose Nalmefene on Preventing Remifentanil-induced Postoperative Hyperalgesia

Primary Purpose

Pain, Anesthesia

Status
Completed
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Normal saline
Remifentanil
Sufentanil
Dexmedetomidine injection
Nalmefene
Sponsored by
Tianjin Medical University General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Pain focused on measuring Remifentanil, Opioid-induced hyperalgesia, Postoperative pain, pain intensity

Eligibility Criteria

20 Years - 65 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients are scheduled to undergo Gynecological surgery under a short general anesthesia of 1-3 hours.
  2. American Society of Anesthesiologists physical status is I-II.
  3. Written informed consent was obtained from all the subjects.

Exclusion Criteria:

  1. Subject has a diagnosis of Coronary heart disease, bronchial asthma, cardiac, lung, hepatic and renal insufficiency.
  2. Subject has a diagnosis of Severe high blood pressure , diabetes, obesity (BMI>30).
  3. Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre-existing therapy with opioids, intake of any analgesic drug within 48 h before surgery.
  4. .Subject has Pregnancy, psychiatric disease.
  5. Subject has any contraindication for the use of patient-controlled analgesia (PCA).
  6. Inability to understand the Study Information Sheet and provide a written consent to take part in the study.

Sites / Locations

  • Tianjin Medical University General Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Placebo Comparator

Sham Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

Normal Saline

Sufentanil

Dexmedetomidine

Nalmefene

Dexmedetomidine-Nalmefene

Arm Description

Normal saline is intravenously administrated before anesthesia induction and intraoperative pain management was with remifentanil

Normal saline is intravenously admistrated before anesthesia induction and intraoperative pain management was with sufentanil

Dexmedetomidine is intravenously administrated at a dose of 0.5ug/kg 10min before anesthesia induction and intraoperative pain management was with remifentanil

Nalmefene is intravenously administrated at a dose of 0.2ug/kg before anesthesia induction and intraoperative pain management was with remifentanil

A dose of 0.1ug/kg nalmefene and a dose of 0.25ug/kg dexmedetomidine for 10 minutes before anesthesia induction and intraoperative pain management was with remifentanil

Outcomes

Primary Outcome Measures

Mechanical Hyperalgesia Threshold on the Dominant Inner Forearm
The mechanical hyperalgesia threshold was defined as the lowest force (g) necessary to bend a Von Frey filament, which was perceived to be painful by the patient and measured by Von Frey filament at 24 hours postoperatively

Secondary Outcome Measures

Normalized Area of Hyperalgesia Around the Incision
The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper' feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament.
Pain Score (Numerical Rating Scale)
The pain score at rest was evaluated by pain 11-point numerical rating scale : 0 = no pain, 10 = greatest imaginable pain.
Time of First Postoperative Analgesic Requirement
First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl.
Cumulative Sufentanyl Consumption
Each patient was administered analgesics using a PCA pump containing sufentanil (100μg) in normal saline at a total volume of 100 ml after leaving post-anaesthesia care unit . This device was set to deliver a basal infusion of 2 ml/h and bolus doses of 0.5 ml with a 15-min lockout period. Sufentanyl cumulative consumption is recorded 24 hours postoperatively
Occurrence of Side Effects
Occurrence of side effects: nausea, vomiting, dizziness, headache, shivering, pruritus,hypotention/hypertention,bradycardia/tachycardia

Full Information

First Posted
March 13, 2017
Last Updated
August 2, 2021
Sponsor
Tianjin Medical University General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03096730
Brief Title
Effect of Dexmedetomidine Combined With Low-dose Nalmefene on Preventing Remifentanil-induced Postoperative Hyperalgesia
Official Title
The Effect of Dexmedetomidine Combined With Low-dose Nalmefene on Preventing Remifentanil-induced Postoperative Hyperalgesia in Patients Undergoing Gynecological Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
February 6, 2017 (Actual)
Primary Completion Date
December 20, 2017 (Actual)
Study Completion Date
December 30, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Tianjin Medical University General Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To explore and compare antihyperalgesic effects of Dexmedetomidine,Nalmefene,and a combination of both received before anesthesia induction. To evaluate and examine the incidence of adverse effects with the purpose of selecting the optimum dose.
Detailed Description
There are a dramatically increasing number of evidences that administration of the potent, ultra-short-acting opioid remifentanil seems to cause opioid-induced hyperalgesia (OIH) more frequently and predictably compared with the others, likely due to its rapid onset and offset. Therefore, prophylaxis of remifentanil induced hyperalgesia is indispensable to postoperative comfort and satisfaction. There is no denying the fact that OIH is related to central glutaminergic system and N-methyl-d-aspartate(NMDA)receptor-activation induced central sensitization. Dexmedetomidine is an 2-adrenergic agonist that has been shown to synergize with opioids. Dexmedetomidine inhibits NMDAR excitability by reducing the phosphorylation of N-methyl-D-aspartate receptor 2B subunit phosphorylation of spinal dorsal horn induced by remifentanil, thereby achieving the goal of reducing OIH. Nalmefene is a pure opioid receptor antagonist that antagonizes the Mu receptor, alleviating the central sensitization of NMDA, thereby reducing OIH. At the same time reported in the literature, opioid receptor has a bimode:On the one hand can be mediated by Gs protein-mediated pain, respiratory depression, nausea and vomiting, etc ; on the other hand can be coupled with Gi / Go protein mediated analgesic effect. Low-dose nalmefene (<1.0ug / kg) and other opioid receptor antagonists can antagonize the role of Gs protein-coupled opioid receptors, blocking the pathway of opioid excitatory effects, thereby reducing the incidence of adverse reactions.The following study is carried out to evaluate whether dexmedetomidine combined with nalmefene can be safely and effectively applied to prevent postoperative hyperalgesia induced by remifentanil in patients undergoing Laparoscopic gynecological surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pain, Anesthesia
Keywords
Remifentanil, Opioid-induced hyperalgesia, Postoperative pain, pain intensity

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
InvestigatorOutcomes Assessor
Masking Description
Double Blind
Allocation
Randomized
Enrollment
150 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Normal Saline
Arm Type
Placebo Comparator
Arm Description
Normal saline is intravenously administrated before anesthesia induction and intraoperative pain management was with remifentanil
Arm Title
Sufentanil
Arm Type
Sham Comparator
Arm Description
Normal saline is intravenously admistrated before anesthesia induction and intraoperative pain management was with sufentanil
Arm Title
Dexmedetomidine
Arm Type
Active Comparator
Arm Description
Dexmedetomidine is intravenously administrated at a dose of 0.5ug/kg 10min before anesthesia induction and intraoperative pain management was with remifentanil
Arm Title
Nalmefene
Arm Type
Active Comparator
Arm Description
Nalmefene is intravenously administrated at a dose of 0.2ug/kg before anesthesia induction and intraoperative pain management was with remifentanil
Arm Title
Dexmedetomidine-Nalmefene
Arm Type
Active Comparator
Arm Description
A dose of 0.1ug/kg nalmefene and a dose of 0.25ug/kg dexmedetomidine for 10 minutes before anesthesia induction and intraoperative pain management was with remifentanil
Intervention Type
Drug
Intervention Name(s)
Normal saline
Other Intervention Name(s)
0. 9% Sodium Chloride Injection
Intervention Description
Normal saline is intravenously administrated before anesthesia induction
Intervention Type
Drug
Intervention Name(s)
Remifentanil
Other Intervention Name(s)
Remifentanil Hydrochloride for Injection
Intervention Description
Remifentanil is intravenously administrated
Intervention Type
Drug
Intervention Name(s)
Sufentanil
Other Intervention Name(s)
Sufentanil injection
Intervention Description
Sufentanil is intravenously administrated
Intervention Type
Drug
Intervention Name(s)
Dexmedetomidine injection
Other Intervention Name(s)
Dexmedetomidine
Intervention Description
Dexmedetomidine is intravenously administrated before anesthesia induction
Intervention Type
Drug
Intervention Name(s)
Nalmefene
Intervention Description
Nalmefene is intravenously administrated before anesthesia induction
Primary Outcome Measure Information:
Title
Mechanical Hyperalgesia Threshold on the Dominant Inner Forearm
Description
The mechanical hyperalgesia threshold was defined as the lowest force (g) necessary to bend a Von Frey filament, which was perceived to be painful by the patient and measured by Von Frey filament at 24 hours postoperatively
Time Frame
24 hours after surgery
Secondary Outcome Measure Information:
Title
Normalized Area of Hyperalgesia Around the Incision
Description
The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper' feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament.
Time Frame
1hours,3hours,6hours,12hours,24hours after surgery
Title
Pain Score (Numerical Rating Scale)
Description
The pain score at rest was evaluated by pain 11-point numerical rating scale : 0 = no pain, 10 = greatest imaginable pain.
Time Frame
1hours,3hours,6hours,12hours,24hours after surgery
Title
Time of First Postoperative Analgesic Requirement
Description
First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl.
Time Frame
postoperative 1 hours
Title
Cumulative Sufentanyl Consumption
Description
Each patient was administered analgesics using a PCA pump containing sufentanil (100μg) in normal saline at a total volume of 100 ml after leaving post-anaesthesia care unit . This device was set to deliver a basal infusion of 2 ml/h and bolus doses of 0.5 ml with a 15-min lockout period. Sufentanyl cumulative consumption is recorded 24 hours postoperatively
Time Frame
1hours,3hours,6hours,12hours,24hours after surgery
Title
Occurrence of Side Effects
Description
Occurrence of side effects: nausea, vomiting, dizziness, headache, shivering, pruritus,hypotention/hypertention,bradycardia/tachycardia
Time Frame
24 hours

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients are scheduled to undergo Gynecological surgery under a short general anesthesia of 1-3 hours. American Society of Anesthesiologists physical status is I-II. Written informed consent was obtained from all the subjects. Exclusion Criteria: Subject has a diagnosis of Coronary heart disease, bronchial asthma, cardiac, lung, hepatic and renal insufficiency. Subject has a diagnosis of Severe high blood pressure , diabetes, obesity (BMI>30). Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre-existing therapy with opioids, intake of any analgesic drug within 48 h before surgery. .Subject has Pregnancy, psychiatric disease. Subject has any contraindication for the use of patient-controlled analgesia (PCA). Inability to understand the Study Information Sheet and provide a written consent to take part in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wang Guolin, MD
Organizational Affiliation
Tianjin Medical University General Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Tianjin Medical University General Hospital
City
Tianjin
State/Province
Tianjin
ZIP/Postal Code
300052
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
data not entered

Learn more about this trial

Effect of Dexmedetomidine Combined With Low-dose Nalmefene on Preventing Remifentanil-induced Postoperative Hyperalgesia

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