Segmental Spinal Anesthesia for Small-incision Cholecystectomy in a Field Hospital (SPICHOL)
Primary Purpose
Gall Stones (& [Calculus - Gall Bladder]), Anesthesia
Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
segmental spinal anesthesia
Sponsored by
About this trial
This is an interventional treatment trial for Gall Stones (& [Calculus - Gall Bladder])
Eligibility Criteria
Inclusion Criteria:
- uncomplicated symptomatic cholelithiasis
- American society of anesthesiologists (ASA) physical status I, II, or III
Exclusion Criteria:
- patients with acute cholecystitis
- suspected common bile duct stones
- previous abdominal surgery
- bleeding diathesis
- spinal abnormality
- allergy to any drug used in the study
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
segmental spinal anesthesia
Arm Description
thoracic spinal anesthesia at T 10 level
Outcomes
Primary Outcome Measures
Feasibility of segmental spinal anesthesia for small-incision open cholecystectomy in a field hospital
Patients' peroperative pain scores assessed on a numeric rating scale ranging from 0 (no pain) to 10 (worst possible pain)
Hemodynamic tolerance of segmental spinal anesthesia.
Heart rate (beats per minute): monitored and recorded every 5 minutes:
Hemodynamic tolerance of segmental spinal anesthesia.
Non-invasive blood pressure (mmHg): monitored and recorded every 5 minutes:
Respiratory safety of segmental spinal anesthesia.
Respiratory rate (breaths per minute): monitored and recorded every 5 minutes.
Respiratory safety of segmental spinal anesthesia.
Pulse oximetry (%): monitored and recorded every 5 minutes.
Secondary Outcome Measures
surgeon's satisfaction with anesthesia technique
numeric scale from 0 to 10 (0: worst surgical conditions, 10: best operative conditions)
patient satisfaction with anesthesia technique
numeric rating scale from 0 to 10
postoperative adverse effects
nausea and vomiting, urinary retention, pruritus, headache, neurologic symptoms
Full Information
NCT ID
NCT05165641
First Posted
August 10, 2017
Last Updated
November 13, 2022
Sponsor
Avicenna Military Hospital
1. Study Identification
Unique Protocol Identification Number
NCT05165641
Brief Title
Segmental Spinal Anesthesia for Small-incision Cholecystectomy in a Field Hospital
Acronym
SPICHOL
Official Title
Segmental Spinal Anesthesia for Small-incision Cholecystectomy in a Field Hospital
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
February 1, 2016 (Actual)
Primary Completion Date
March 31, 2017 (Actual)
Study Completion Date
March 31, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Avicenna Military 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
Providing safe and efficient anesthesia and in a field hospital is a challenging situation. This study investigated the feasibility and safety of thoracic spinal anesthesia for small-incision open cholecystectomy in a deployed field hospital.
Detailed Description
This study was conducted in a field hospital deployed in a rural area of the middle Atlas in Morocco during the winters of 2016 and 2017. The Middle Atlas is a part of the Atlas mountain range which is usually blocked and isolated by snow during the winter. The hospital deployed was an inflatable tent hospital self-contained and self-sufficient. This field hospital included the following components: a patient's ward (sixty beds), an operating theater with one surgical table, a recovery room with 2 beds, a laboratory, an X-ray unit, a pharmacy, and several exams rooms.
After approval by the Ethical review board of Avicenna Military Hospital, Marrakech, Morocco (CERB7/2016), written informed consent was obtained from patients who agreed to participate in the study.
The inclusion criteria were: uncomplicated symptomatic cholelithiasis confirmed by preoperative ultrasound, age 18 years or older and American society of anesthesiologists (ASA) physical status I, II or III. Exclusion criteria were: patients with acute cholecystitis, suspected common bile duct stones, previous abdominal surgery, bleeding diathesis, spinal abnormality, and allergy to any drug used in the study.
Patients were interviewed and examined by an anesthesiologist in a preoperative visit several days before surgery. On arrival in the operating room the patient's non-invasive blood pressure, oxygen saturation, and heart rate were monitored. Heart rate and blood pressure were recorded every five minutes. Intravenous access was established in the forearm with an 18 Gauge catheter and patients received a preload with 10 ml/Kg of normal saline. Patients were given 1mg midazolam intravenously for anxiolysis and oxygen 2-3 l /min was administered by a nasal cannula. Cefazolin 2 g was injected as antimicrobial prophylaxis. Antiemetic prophylaxis was also carried out with dexamethasone 4 mg IV.
Spinal anesthesia was performed at a lower thoracic level with the patient in the sitting position. After local anesthesia with 1% lidocaine, the spinal puncture was done in the 10th thoracic intervertebral space (T 10) through a median approach. A 27 Gg pencil-point needle with an introducer was used (marquee). To identify T 10, the vertebra prominens (C7) was palpated and the spinous processes were palpated caudally. Two senior anesthesiologists performed all the spinal punctures. The progression of the spinal needle was cautious and soft. The effort was made to stop the needle progression just after the tactile perception of the dura mater. Once the flow of cerebrospinal fluid was obtained, 1.5 ml of hyperbaric bupivacaine 5mg/ml (=7.5 mg) mixed with 0.5 ml of fentanyl 50 µg/ml (= 25 µg) was injected and the spinal needle removed. Patients were asked to report any pain or paresthesia during the puncture. The patient was then placed in a supine horizontal position. The level of sensory block was assessed every 2 minutes (pinprick method). After an adequate sensory block was obtained (T4 - T 12), surgery was allowed to start. The nasogastric tube was not inserted unless the surgeon required it.
Patients were invited to report any discomfort or pain during surgery. Patients were asked to assess any eventual pain on a numeric rating scale ranging from 0 (no pain) to 10 (worst possible pain). Perioperative pain scores were collected at skin incision and perioperative pain and anxiety were treated with boluses of fentanyl 50 µg (maximum 100 µg) and midazolam 1 mg (maximum 5 mg). The need for additional sedation/analgesia and the doses administered were recorded. Patients were informed about the possibility of switching to general anesthesia (GA). Criteria for conversion to GA were: failure of spinal anesthesia, pain score > 4 despite a maximum dose of fentanyl, and difficult surgical conditions.
Two experienced surgeons performed all operations. Small incision open cholecystectomy was performed with a 6 to 8 cm long transverse incision over the right rectus abdominis muscle, as described by Rosenmuller [ref]. Surgeon s satisfaction was evaluated by asking surgeons to assess the operative conditions on a numeric scale of 0 to 10 (0: worst surgical conditions, 10: best operative conditions). At the time of skin closure, a wound infiltration (muscular compartment and subcutaneous fat) with 15 to 20ml of bupivacaine 0.25% was made.
The duration of surgery and perioperative incidents (hypotension, bradycardia nausea, and/or vomiting) were recorded. Hypotension defined as a drop in the mean arterial blood pressure (MAP) ≥20% below baseline was managed by IV boluses of ephedrine 6 mg. Bradycardia was defined as heart rate <50 and treated with atropine 0.50 mg. Post-operative events were also recorded: nausea and vomiting, urinary retention, pruritus, headache, or neurologic symptom. Patients were discharged the day after the surgery.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gall Stones (& [Calculus - Gall Bladder]), Anesthesia
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
62 (Actual)
8. Arms, Groups, and Interventions
Arm Title
segmental spinal anesthesia
Arm Type
Other
Arm Description
thoracic spinal anesthesia at T 10 level
Intervention Type
Procedure
Intervention Name(s)
segmental spinal anesthesia
Intervention Description
Spinal anesthesia was performed at a lower thoracic level with the patient in the sitting position. After local anesthesia with 1% lidocaine, the spinal puncture was done in the 10th thoracic intervertebral space (T 10) through a median approach. A 27 Gg pencil-point needle with an introducer was used (marquee). To identify T 10, the vertebra prominens (C7) was palpated and the spinous processes were palpated caudally [ref}. Two senior anesthesiologists performed all the spinal punctures. The progression of the spinal needle was cautious and soft. The effort was made to stop the needle progression just after the tactile perception of the dura mater. Once the flow of cerebrospinal fluid was obtained, 1.5 ml of hyperbaric bupivacaine 5mg/ml (=7.5 mg) mixed with 0.5 ml of fentanyl 50 µg/ml (= 25 µg) was injected and the spinal needle removed.
Primary Outcome Measure Information:
Title
Feasibility of segmental spinal anesthesia for small-incision open cholecystectomy in a field hospital
Description
Patients' peroperative pain scores assessed on a numeric rating scale ranging from 0 (no pain) to 10 (worst possible pain)
Time Frame
intraoperatively
Title
Hemodynamic tolerance of segmental spinal anesthesia.
Description
Heart rate (beats per minute): monitored and recorded every 5 minutes:
Time Frame
intraoperatively
Title
Hemodynamic tolerance of segmental spinal anesthesia.
Description
Non-invasive blood pressure (mmHg): monitored and recorded every 5 minutes:
Time Frame
intraoperatively
Title
Respiratory safety of segmental spinal anesthesia.
Description
Respiratory rate (breaths per minute): monitored and recorded every 5 minutes.
Time Frame
intraoperatively
Title
Respiratory safety of segmental spinal anesthesia.
Description
Pulse oximetry (%): monitored and recorded every 5 minutes.
Time Frame
intraoperatively
Secondary Outcome Measure Information:
Title
surgeon's satisfaction with anesthesia technique
Description
numeric scale from 0 to 10 (0: worst surgical conditions, 10: best operative conditions)
Time Frame
intraoperatively
Title
patient satisfaction with anesthesia technique
Description
numeric rating scale from 0 to 10
Time Frame
24 hours postoperatively
Title
postoperative adverse effects
Description
nausea and vomiting, urinary retention, pruritus, headache, neurologic symptoms
Time Frame
24 hours postoperatively
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
uncomplicated symptomatic cholelithiasis
American society of anesthesiologists (ASA) physical status I, II, or III
Exclusion Criteria:
patients with acute cholecystitis
suspected common bile duct stones
previous abdominal surgery
bleeding diathesis
spinal abnormality
allergy to any drug used in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Younes Aissaoui
Organizational Affiliation
Avicenna Military Hospital
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
No
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Segmental Spinal Anesthesia for Small-incision Cholecystectomy in a Field Hospital
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