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Esketamine vs. Ketorolac for Prevention of Postoperative Pain and Cognitive Dysfunction After Total Knee Arthroplasty

Primary Purpose

Postoperative Pain, Postoperative Cognitive Dysfunction, Total Knee Arthroplasty

Status
Recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Normal saline
Esketamine at high dose
Esketamine at low dose
Ketorolac at high dose
Ketorolac at low dose
Sponsored by
Tianjin Medical University General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Postoperative Pain focused on measuring esketamine, ketorolac

Eligibility Criteria

65 Years - 85 Years (Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject is scheduled to undergo total knee arthroplasty under a short general anesthesia of less than 2 hours
  2. Subject's American Society of Anesthesiologists physical status is I-II.
  3. The subject's parent/legally authorized guardian has given written informed consent to participate.

Exclusion Criteria:

  1. Subject has a diagnosis of bronchial asthma, coronary heart disease, severe hypertension, renal failure or liver failure.
  2. Subject has a diagnosis of Insulin dependent diabetes.
  3. Subject is allergy and contraindication to esketamine or ketorolac.
  4. Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre- existing therapy with opioids.
  5. Subject has any contraindication for the use of patient-controlled analgesia (PCA).
  6. Subject is pregnant or breast-feeding.
  7. Subject is obese (body mass index >30kg/m^2).
  8. Subject is incapacity to comprehend pain assessment and cognitive assessment.

Sites / Locations

  • Tianjin Medical University General HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Placebo Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

Normal saline in patients

Esketamine in patients

Ketorolac in patients

Esketamine and Ketorolac in patients

Arm Description

After the induction of anesthesia, normal saline is intravenously injected in a volume of 2ml, and then a continuous infusion of 20 ml/h normal saline until starting skin suture.

After the induction of anesthesia, esketamine is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h esketamine until starting skin suture.

After the induction of anesthesia, ketorolac is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h ketorolac until starting skin suture.

After the induction of anesthesia, 0.2mg/kg esketamine and 0.2mg/kg ketorolac are intravenously injected, and then a continuous infusion of 0.2mg/kg/h esketamine and 0.2mg/kg/h ketorolac until starting skin suture.

Outcomes

Primary Outcome Measures

Cumulative opioid Consumption
Each patient was administered analgesics using a PCA (Patient-controlled analgesia) pump containing sufentanil in normal saline after leaving PACU (Postanesthesia care unit). Sufentanyl cumulative consumption is recorded 72 hours postoperatively

Secondary Outcome Measures

Pain Score (NRS) after movement
The pain score after movement was evaluated by pain 11-point numerical rating scale (NRS): 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.
Total Dose of First Postoperative Analgesic Requirement
First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl.
Mini-Mental State Examination (MMSE)
Cognitive performance was assessed with 0-30 points Mini-Mental State Examination (MMSE) scale. Greater scores means better outcome.
The incidence of Side Effects
The number of patients with post-operative side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus was recorded 72 hours after surgery.
The levels of TNF-a in blood
Blood samples are collected to measure the levels of cytokine TNF-a using ELISA kits.
The levels of chemokine CXCL1 in blood
Blood samples are collected to measure the levels of chemokine CXCL1 using ELISA kits.
The levels of neuron specific enolase (NSE) in blood
Blood samples are collected to measure the levels of neuron specific enolase (NSE) using electrochemilumiscence kit.
The levels of S-100 calcium-binding protein B in blood
Blood samples are collected to measure the levels of S-100 calcium-binding protein B using electrochemilumiscence kit.
The levels of cortisol in blood
Blood samples are collected to measure the levels of cortisol using electrochemilumiscence kit.
Pain Score (NRS) at rest
The pain score at rest was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10 = greatest imaginable pain.
The levels of chemokine CCL7 in blood
Blood samples are collected to measure the levels of chemokine CCL7 using ELISA kits.
The levels of IL-18 in blood
Blood samples are collected to measure the levels of cytokine IL-18 using ELISA kits.
The levels of IL-23 in blood
Blood samples are collected to measure the levels of cytokine IL-23 using ELISA kits.
The levels of IL-17 in blood
Blood samples are collected to measure the levels of cytokine IL-17 using ELISA kits.

Full Information

First Posted
October 28, 2021
Last Updated
April 8, 2022
Sponsor
Tianjin Medical University General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05132595
Brief Title
Esketamine vs. Ketorolac for Prevention of Postoperative Pain and Cognitive Dysfunction After Total Knee Arthroplasty
Official Title
Esketamine vs. Ketorolac for Prevention of Postoperative Pain and Cognitive Dysfunction After Total Knee Arthroplasty in Patients: a Randomized Double-blind Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 30, 2021 (Actual)
Primary Completion Date
July 15, 2022 (Anticipated)
Study Completion Date
July 30, 2022 (Anticipated)

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
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Purpose: To compare esketamine and ketorolac separately and in combination to prevent postoperative pain and cognitive dysfunction after total knee arthroplasty
Detailed Description
With the increase in human life span, orthopedic injuries and subsequent repair surgery have become a major health problem which impairs the life quality of patients and burdens healthcare systems worldwide. Poor post-surgical pain control is a leading factor that hinders the physical rehabilitation and musculoskeletal functional recovery, and causes acute cognitive impairment and chronic pain syndrome. Therefore, prophylaxis of postoperative pain is indispensable to postoperative comfort and satisfaction. There is no denying the fact that pathologic pain is related to central glutaminergic system and N-methyl-d-aspartate (NMDA) receptor activation induced central sensitization. Also, it is previously reported that neuroinflammation is associated with pain development and cognitive dysfunction. Ketamine, a NMDA receptor antagonist, is effective in reversing NMDA receptor activation underlying pain states. But the side effects of ketamine limit its clinical application, such as gibberish and agitation. It is clarified that esketamine has lower side effects than ketamine and that antinociception of esketamine is stronger than ketamine. The following study is carried out to evaluate whether esketamine and ketorolac can prevent postoperative pain and cognitive impairment after total knee arthroplasty in patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Postoperative Pain, Postoperative Cognitive Dysfunction, Total Knee Arthroplasty
Keywords
esketamine, ketorolac

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Normal saline in patients
Arm Type
Placebo Comparator
Arm Description
After the induction of anesthesia, normal saline is intravenously injected in a volume of 2ml, and then a continuous infusion of 20 ml/h normal saline until starting skin suture.
Arm Title
Esketamine in patients
Arm Type
Active Comparator
Arm Description
After the induction of anesthesia, esketamine is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h esketamine until starting skin suture.
Arm Title
Ketorolac in patients
Arm Type
Active Comparator
Arm Description
After the induction of anesthesia, ketorolac is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h ketorolac until starting skin suture.
Arm Title
Esketamine and Ketorolac in patients
Arm Type
Active Comparator
Arm Description
After the induction of anesthesia, 0.2mg/kg esketamine and 0.2mg/kg ketorolac are intravenously injected, and then a continuous infusion of 0.2mg/kg/h esketamine and 0.2mg/kg/h ketorolac until starting skin suture.
Intervention Type
Drug
Intervention Name(s)
Normal saline
Other Intervention Name(s)
0. 9% Sodium Chloride Injection
Intervention Description
After the induction of anesthesia, normal saline is intravenously injected in a volume of 2ml, and then a continuous infusion of 20ml/h normal saline until starting skin suture.
Intervention Type
Drug
Intervention Name(s)
Esketamine at high dose
Other Intervention Name(s)
Esketamine Hydrochloride Injection
Intervention Description
After the induction of anesthesia, esketamine is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h esketamine until starting skin suture.
Intervention Type
Drug
Intervention Name(s)
Esketamine at low dose
Other Intervention Name(s)
Esketamine Hydrochloride Injection
Intervention Description
After the induction of anesthesia, esketamine is intravenously injected at 0.2mg/kg, and then a continuous infusion of 0.2mg/kg/h esketamine until starting skin suture.
Intervention Type
Drug
Intervention Name(s)
Ketorolac at high dose
Other Intervention Name(s)
Ketorolac Tromethamine
Intervention Description
After the induction of anesthesia, Ketorolac is intravenously injected at 0.4mg/kg, and then a continuous infusion of 0.4mg/kg/h Ketorolac until starting skin suture.
Intervention Type
Drug
Intervention Name(s)
Ketorolac at low dose
Other Intervention Name(s)
Ketorolac Tromethamine
Intervention Description
After the induction of anesthesia, Ketorolac is intravenously injected at 0.2mg/kg, and then a continuous infusion of 0.2mg/kg/h Ketorolac until starting skin suture.
Primary Outcome Measure Information:
Title
Cumulative opioid Consumption
Description
Each patient was administered analgesics using a PCA (Patient-controlled analgesia) pump containing sufentanil in normal saline after leaving PACU (Postanesthesia care unit). Sufentanyl cumulative consumption is recorded 72 hours postoperatively
Time Frame
72 hours after surgery
Secondary Outcome Measure Information:
Title
Pain Score (NRS) after movement
Description
The pain score after movement was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10 = greatest imaginable pain.
Time Frame
72 hours after surgery
Title
Time of First Postoperative Analgesic Requirement
Description
First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl.
Time Frame
1 hour after surgery
Title
Total Dose of First Postoperative Analgesic Requirement
Description
First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl.
Time Frame
1 hour after surgery
Title
Mini-Mental State Examination (MMSE)
Description
Cognitive performance was assessed with 0-30 points Mini-Mental State Examination (MMSE) scale. Greater scores means better outcome.
Time Frame
72 hours after surgery
Title
The incidence of Side Effects
Description
The number of patients with post-operative side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus was recorded 72 hours after surgery.
Time Frame
72 hours after surgery
Title
The levels of TNF-a in blood
Description
Blood samples are collected to measure the levels of cytokine TNF-a using ELISA kits.
Time Frame
72 hours after surgery
Title
The levels of chemokine CXCL1 in blood
Description
Blood samples are collected to measure the levels of chemokine CXCL1 using ELISA kits.
Time Frame
72 hours after surgery
Title
The levels of neuron specific enolase (NSE) in blood
Description
Blood samples are collected to measure the levels of neuron specific enolase (NSE) using electrochemilumiscence kit.
Time Frame
72 hours after surgery
Title
The levels of S-100 calcium-binding protein B in blood
Description
Blood samples are collected to measure the levels of S-100 calcium-binding protein B using electrochemilumiscence kit.
Time Frame
72 hours after surgery
Title
The levels of cortisol in blood
Description
Blood samples are collected to measure the levels of cortisol using electrochemilumiscence kit.
Time Frame
72 hours after surgery
Title
Pain Score (NRS) at rest
Description
The pain score at rest was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10 = greatest imaginable pain.
Time Frame
72 hours after surgery
Title
The levels of chemokine CCL7 in blood
Description
Blood samples are collected to measure the levels of chemokine CCL7 using ELISA kits.
Time Frame
72 hours after surgery
Title
The levels of IL-18 in blood
Description
Blood samples are collected to measure the levels of cytokine IL-18 using ELISA kits.
Time Frame
72 hours after surgery
Title
The levels of IL-23 in blood
Description
Blood samples are collected to measure the levels of cytokine IL-23 using ELISA kits.
Time Frame
72 hours after surgery
Title
The levels of IL-17 in blood
Description
Blood samples are collected to measure the levels of cytokine IL-17 using ELISA kits.
Time Frame
72 hours after surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is scheduled to undergo total knee arthroplasty under a short general anesthesia of less than 2 hours Subject's American Society of Anesthesiologists physical status is I-II. The subject's parent/legally authorized guardian has given written informed consent to participate. Exclusion Criteria: Subject has a diagnosis of bronchial asthma, coronary heart disease, severe hypertension, renal failure or liver failure. Subject has a diagnosis of Insulin dependent diabetes. Subject is allergy and contraindication to esketamine or ketorolac. Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre- existing therapy with opioids. Subject has any contraindication for the use of patient-controlled analgesia (PCA). Subject is pregnant or breast-feeding. Subject is obese (body mass index >30kg/m^2). Subject is incapacity to comprehend pain assessment and cognitive assessment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Guolin Wang, MD
Phone
+8615822855556
Email
wangguolinghad@hotmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Guolin Wang
Organizational Affiliation
Tianjin Medical University General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tianjin Medical University General Hospital
City
Tianjin
ZIP/Postal Code
300052
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Guolin Wang
Phone
+8618604755166

12. IPD Sharing Statement

Plan to Share IPD
No

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Esketamine vs. Ketorolac for Prevention of Postoperative Pain and Cognitive Dysfunction After Total Knee Arthroplasty

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