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Inferior Alveolar Nerve Block for Intraoperative Analgesia for Maxillofacial Cancer Surgery - RCT

Primary Purpose

Mandibular Neoplasms

Status
Completed
Phase
Not Applicable
Locations
India
Study Type
Interventional
Intervention
inferior alveolar nerve block
Sponsored by
Tata Memorial Centre
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mandibular Neoplasms

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • All patients between the age of 18 and 75 yrs classified as ASA I and II physical status requiring maxillofacial cancer surgery requiring unilateral mandibular resection and unilateral neck dissection

Exclusion Criteria:

  • - surgery involving upper alveolar / maxillary resection
  • patients with BMI below 18kg/m2 and above 30kg/m2
  • allergy to local anaesthetic agent
  • Inability to give inferior alveolar nerve block due to any cause e.g. restricted mouth opening, obscured landmark or infection at site
  • pregnant women
  • patients unable to give valid consent e.g. patients with learning difficulties
  • patients on medications for hypertension
  • patients with preoperative pain requiring regular pain medications
  • uncontrolled haemodynamic status e.g. baseline arterial blood pressure above 160 /90 and baseline HR above 100 /min

Sites / Locations

  • Tata Memorial Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Nerve block

control

Arm Description

This arm will receive inferior alveolar nerve block

Control arm will not receive inferior alveolar block

Outcomes

Primary Outcome Measures

IV fentanyl requirement during primary tumour removal
The total IV fentanyl dose required during primary tumour removal will be noted

Secondary Outcome Measures

IV fentanyl requirement during neck dissection and primary tumour removal
The total IV fentanyl dose required during neck dissection and primary tumour removal will be noted
Maximum change in heart rate from baseline during primary tumour removal
Maximum change in blood pressure from baseline during primary tumour removal
Need for rescue analgesics or vasoactive agents during primary tumour removal

Full Information

First Posted
April 15, 2016
Last Updated
November 20, 2016
Sponsor
Tata Memorial Centre
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1. Study Identification

Unique Protocol Identification Number
NCT02745288
Brief Title
Inferior Alveolar Nerve Block for Intraoperative Analgesia for Maxillofacial Cancer Surgery - RCT
Official Title
Inferior Alveolar Nerve Block for Intraoperative Analgesia for Maxillofacial Cancer Surgery Requiring Unilateral Mandibular Resection-A Randomized Controlled Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2016
Overall Recruitment Status
Completed
Study Start Date
June 2016 (undefined)
Primary Completion Date
October 2016 (Actual)
Study Completion Date
October 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Tata Memorial Centre

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Mandibular resection which is an important component of maxillofacial cancer surgery is an extremely painful procedure associated with severe sympathetic response needing high doses of opioids. Inferior alveolar nerve block is a common nerve block used by dentists for mandibular dental extractions. The aim of this trial is to study the effect of this block for intraoperative analgesia in maxillofacial cancer surgeries requiring unilateral mandibular resection.
Detailed Description
All adult patients below 75yrs of age scheduled for maxillofacial surgery will be screened for inclusion and exclusion criteria. Written informed consent will be taken one day prior to surgery. Consenting subjects will be randomized after induction of anaesthesia to study or control arm. The duration of the study is from induction of anaesthesia to the completion of primary tumour removal and neck dissection Study procedure: Ipsilateral Inferior alveolar nerve block A long acting local anaesthetic agent Inj Bupivacaine hydrochloride 0.5% (2 ml) will be given after induction by open mouth technique by landmark method. The mucobuccal fold will be palpated and traced till coronoid notch. The finger will be moved medially across the retromandibular trigone on internal oblique ridge. The 25G needle will be inserted till bone is felt. 2 ml of 0.5% bupivacaine will be injected slowly after withdrawing needle by 1mm and confirming negative aspiration of blood. Control arm will not receive any intervention. The study investigator will give a mock injection for blinding of the attending anaesthetist The study procedure will be done by the study investigators 10 -30 minutes prior to commencing surgery for primary tumour. Account of procedure: All patients will have standard conduct of anaesthesia except for the alveolar nerve injection in the study group. All patients will have the minimum standard monitoring of pulse oximeter, electrocardiogram, capnography and non invasive blood pressure monitoring. Blood pressure and heart rate will be recorded every 5 min interval from the beginning till completion of primary tumor excision and neck dissection Induction of anaesthesia: IV fentanyl 2 mcg/kg, IV Propofol 2 -3 mg/kg. IV neuromuscular blocking agent used will be Inj vecuronium bromide in the dose of 0.1 mg /kg. All patients will have standard airway management at the discretion of the attending anaesthesiologist. Intraoperative maintenance of anaesthesia will be as follows Controlled ventilation with isoflurane in air / oxygen with minimal alveolar concentration of 0.8 -1.2 Intraoperative analgesic - IV fentanyl in boluses of 1 mcg/kg at the discretion of the anaesthetist based on the haemodynamic response till the completion of primary tumour removal and neck dissection. Thereafter, the choice of analgesic will be left to the anaesthetist In case of uncontrolled sympathetic response (hypertension and/or tachycardia) to surgery not controlled by IV fentanyl (10 mcg/kg ), rescue intraoperative analgesic/ anaesthetic (e.g.IV morphine, IV diclofenac, IV dexmedetomide, IV propofol, increase in inhalational anaesthetic concentration, etc) or vasoactive agents (e.g.IV Esmolol, IV Nitroglycerin, etc) may be used. This will be noted in the Case record form. Information will be collected as per Case Record form by the investigator. Any deviation from protocol will be recorded. Sample size calculation Based on the average fentanyl requirement 340mcg found in pilot data, to detect 25% reduction in fentanyl requirement in the study group compared to control group, with 80% power and level of significance of 5% ,the sample size calculated was 22 in each group. Statistical Analysis The fentanyl requirement in the two groups, maximum heart rate and maximum blood pressure will be will be compared using students t test Other variables will be described as numbers and percentage Demographic ,clinical and disease relate variable will be present as frequency (percentage) and mean (S.D.) or median as appropriate. Two group comparisons will be made using independent t-test or Man Whitney U test as per distribution of the data. P-value< 0.05 will be considered statistical significant. Repeated measures ANOVA will be used to compare change of blood pressure and heart rate from baseline at various time points.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mandibular Neoplasms

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
50 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nerve block
Arm Type
Experimental
Arm Description
This arm will receive inferior alveolar nerve block
Arm Title
control
Arm Type
No Intervention
Arm Description
Control arm will not receive inferior alveolar block
Intervention Type
Procedure
Intervention Name(s)
inferior alveolar nerve block
Intervention Description
A long acting local anaesthetic agent Inj Bupivacaine hydrochloride 0.5% (2 ml) will be given after induction by open mouth technique by landmark method. The mucobuccal fold will be palpated and traced till coronoid notch. The finger will be moved medially across the retromandibular trigone on internal oblique ridge. The 25G needle will be inserted till bone is felt. 2 ml of 0.5% bupivacaine will be injected slowly after withdrawing needle by 1mm and confirming negative aspiration of blood.
Primary Outcome Measure Information:
Title
IV fentanyl requirement during primary tumour removal
Description
The total IV fentanyl dose required during primary tumour removal will be noted
Time Frame
From start to finish ofprimary tumour removal procedure
Secondary Outcome Measure Information:
Title
IV fentanyl requirement during neck dissection and primary tumour removal
Description
The total IV fentanyl dose required during neck dissection and primary tumour removal will be noted
Time Frame
From start to finish of neck dissection and primary tumour removal
Title
Maximum change in heart rate from baseline during primary tumour removal
Time Frame
From start to finish of primary tumour removal procedure
Title
Maximum change in blood pressure from baseline during primary tumour removal
Time Frame
From start to finish of primary tumour removal procedure
Title
Need for rescue analgesics or vasoactive agents during primary tumour removal
Time Frame
From start to finish of primary tumour removal procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All patients between the age of 18 and 75 yrs classified as ASA I and II physical status requiring maxillofacial cancer surgery requiring unilateral mandibular resection and unilateral neck dissection Exclusion Criteria: - surgery involving upper alveolar / maxillary resection patients with BMI below 18kg/m2 and above 30kg/m2 allergy to local anaesthetic agent Inability to give inferior alveolar nerve block due to any cause e.g. restricted mouth opening, obscured landmark or infection at site pregnant women patients unable to give valid consent e.g. patients with learning difficulties patients on medications for hypertension patients with preoperative pain requiring regular pain medications uncontrolled haemodynamic status e.g. baseline arterial blood pressure above 160 /90 and baseline HR above 100 /min
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Madhavi Shetmahajan, MD
Organizational Affiliation
Tata Memorial Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tata Memorial Hospital
City
Mumbai
ZIP/Postal Code
400012
Country
India

12. IPD Sharing Statement

Plan to Share IPD
No

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Inferior Alveolar Nerve Block for Intraoperative Analgesia for Maxillofacial Cancer Surgery - RCT

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