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Pain, PostoperativeNCT05843344

Dexmedetomidine and Morphine as Adjuvants to US Guided Erector Spinae Plane Blocks in Elective Thoracic Surgeries

A study testing erector spinae plane block with a combination of ropivacaine and morphine, erector spinae plane block with a combination of ropivacaine and dexmedetomidine and erector spinae plane block with ropivacaine only in people with Pain, Postoperative and Pain, Acute, run by Dr Kassiani Theodoraki at 2 sites in Greece.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The aim of this study will be to compare the effects of morphine versus dexmedetomidine when used as adjuvants to local anesthetic (Ropivacaine) in Erector Spinae Plane Block under ultrasound guidance. A group without an adjuvant will also be compared to the groups. Read more about this study

Who is it for?
Ages 25 to 80 years
Conditions the study is for
Pain, Postoperative, Pain, Acute, Pain, Chronic
What is being tested?
erector spinae plane block with a combination of ropivacaine and morphine, erector spinae plane block with a combination of ropivacaine and dexmedetomidine and erector spinae plane block with ropivacaine only
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
2 sitesGreece
Study dates
1 May 2023to 1 May 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 25 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • patients undergoing elective thoracotomy for any cause (ASA I-III)

Who cannot join

  • known allergy to local anesthetic
  • local inflammation
  • severe respiratory distress ( breathing dependence on accessory muscles)
  • severe spinal deformities
  • severe ipsilateral diaphragmatic paresis
  • morbid obesity (BMI>35 kg/m2)
Show all 12Show fewer
  • blood coagulation disorder
  • known contraindication for administration of dexmedetomidine or morphine
  • severe cardiovascular disease
  • systematic use of opioids due to chronic pain
  • renal or hepatic failure
  • patients who refuse to participate.

Trial locations and contacts

2 sites in 1 country.

Kassiani Theodoraki, PhD DESA contact

+306974634162

ktheodoraki@hotmail.com

Greece2 sites
  • Sotiria Thoracic Diseases Hospital

    Athens, 11527

    Dimitra Papadopoulou, MD, MSc, +306942466678, dim.dim.pap@gmail.com

  • Aretaieion University Hospital

    Athens, 11528

    Kassiani Theodoraki, PhD, DESA, +306974634162

Other trials in Greece

About this study

The aim of this study will be to compare the effects of morphine versus dexmedetomidine when used as adjuvants to local anesthetic (Ropivacaine) in Erector Spinae Plane Block under ultrasound guidance. A group without an adjuvant will also be compared to the groups.

Read the detailed description

Erector Spinae Plane Block (ESPB) was first introduced in 2016 as a treatment technique for chronic thoracic neuropathic pain, and rapidly became popular in peri-operative medicine due to its relatively simple technique and low complication rate. It has been also used extensively in thoracic surgery. According to a systematic review, ESPB can be used effectively as part of multimodal analgesia in thoracic surgery since, when used, opioid consumption decreases.

The use of adjuvants has been studied to a limited extent in ESPB. Dexmedetomidine and dexamethasone have been tried as adjuvants in ESPB and it has been shown that dexmedetomidine is more effective in block prolongation and post-operative opioid consumption. According to our knowledge, morphine has not been used yet as an adjuvant for ESPB.

Therefore, the investigators will perform a randomized controlled trial in order to compare morphine and dexmedetomidine as adjuvants in ESPB in elective thoracotomies in terms of intraoperative and post-operative opioid consumption. Intraoperative opioid consumption will be guided by vital signs and Nociception-Level Index (NOL) and post-operative opioid consumption will be measured by the amount of morphine consumed by the patient during the first 48 hours post-operatively. Secondary outcomes will also be recorded.

Being tested
erector spinae plane block with a combination of ropivacaine and morphine, erector spinae plane block with a combination of ropivacaine and dexmedetomidine, erector spinae plane block with ropivacaine only
Medical subject headings
Pain, Postoperative, Acute Pain, Chronic Pain, Agnosia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • erector spinae plane block with a combination of ropivacaine and morphineDrug

    Also called ropivacaine plus morphine

    Before surgery, a US guided ESPB will be performed, and a catheter will be placed. Serratus Anterior Plane Block (SAPB) will be also performed without catheter placement. 20 mL of Ropivacaine 0.375% will be injected in the SAPB. In this group, 19 mL of 0.375% Ropivacaine + 2 mg (1mL) of morphine will be injected in the ESPB. Continuous peripheral nerve catheters will be placed for postoperative analgesia under the Erector Spinae muscle. A pump of 497 ml of 0.2 % ropivacaine + 6 mg of morphine (contained in 3 mL) will be connected to the catheter after the end of the surgery, and the continuous dose will be 10 mL/hr

  • erector spinae plane block with a combination of ropivacaine and dexmedetomidineDrug

    Also called ropivacaine plus dexmedetomidine

    Before surgery, a US guided ESPB will be performed, and a catheter will be placed. SAPB will be also performed without catheter placement. 20 mL of Ropivacaine 0.375% will be injected in the SAPB. In this group, 19 mL of 0.375% Ropivacaine +0.5 mcg/kg (1mL) of dexmedetomidine will be injected in the ESPB. Continuous peripheral nerve catheters will be placed for postoperative analgesia under the Erector Spinae muscle. A pump of 497 ml of 0.2 % ropivacaine + 200 mcg of dexmedetomidine (contained in 3 mL) will be connected to the catheter after the end of the surgery, and the continuous dose will be 10 mL/hr

  • erector spinae plane block with ropivacaine onlyDrug

    Also called ropivacaine only

    Before surgery, a US guided ESPB will be performed, and a catheter will be placed. SAPB will be also performed without catheter placement. 20 mL of Ropivacaine 0.375% will be injected in the SAPB. In this group, 19 mL of 0.375% Ropivacaine +1 mL of normal saline will be injected in the ESPB. Continuous peripheral nerve catheters will be placed for postoperative analgesia under the Erector Spinae muscle. A pump of 497 ml of 0.2 % ropivacaine + 3 mL of normal saline will be connected to the catheter after the end of the surgery, and the continuous dose will be 10 mL/hr

Study groups in NCT05843344
Study groupRoleWhat they receive
ropivacaine and morphine groupActive comparatorerector spinae plane block with a combination of ropivacaine and morphine
Receives: Drug: erector spinae plane block with a combination of ropivacaine and morphine
ropivacaine and dexmedetomidine groupActive comparatorerector spinae plane block with a combination of ropivacaine and dexmedetomidine
Receives: Drug: erector spinae plane block with a combination of ropivacaine and dexmedetomidine
ropivacaine groupActive comparatorerector spinae plane block with ropivacaine only
Receives: Drug: erector spinae plane block with ropivacaine only

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intravenous morphine consumption in the first 48 hours post-operatively

    Patients will be tracked for cumulative morphine consumption through a patient controlled analgesia device for the first 48 hours.

    Measured: 48 hours post-operatively

Secondary outcomes (23)
  1. IV morphine consumption in the first 6 hours

    Patients will be tracked for cumulative morphine consumption through a patient controlled analgesia device for the first 6 hours.

    Measured: 6 hours post-operatively

  2. IV morphine consumption in the first 12 hours

    Patients will be tracked for cumulative morphine consumption through a patient controlled analgesia device for the first 12 hours.

    Measured: 12 hours post-operatively

  3. IV morphine consumption in the first 24 hours

    Patients will be tracked for cumulative morphine consumption through a patient controlled analgesia device for the first 24 hours.

    Measured: 24 hours post-operatively

  4. Intraoperative remifentanil consumption

    intraoperative remifentanil consumption will be monitored according to nociception level (NOL) index

    Measured: Duration of operation

  5. Intraoperative morphine consumption

    Intraoperative morphine consumption will be monitored according to nociception level (NOL) index

    Measured: Duration of operation

  6. Pain score after surgery (PACU)

    Pain score by the use of Numeric Rating Scale (NRS) on arrival at PACU , from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: immediately post-operatively

  7. Pain score 6 hours post-operatively

    Pain score by the use of Numeric Rating Scale (NRS) 6 hours post-operatively , from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 6 hours post-operatively

  8. Pain score 12 hours post-operatively

    Pain score by the use of Numeric Rating Scale (NRS) 12 hours post-operatively , from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 12 hours post-operatively

  9. Pain score 24 hours post-operatively

    Pain score by the use of Numeric Rating Scale (NRS) 24 hours post-operatively , from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 24 hours post-operatively

  10. Pain score 48 hours post-operatively

    Pain score by the use of Numeric Rating Scale (NRS) 48 hours post-operatively , from 0 to 10, where 0 means "no pain" and 10 means "worst pain imaginable"

    Measured: 48 hours post-operatively

  11. side effects post-operatively

    patients will be monitored for any side effects post-operatively

    Measured: 48 hours post-operatively

  12. satisfaction from post-operative analgesia

    satisfaction from post-operative analgesia on a four-point Likert scale with 1 marked as minimal satisfaction and 4 as maximal satisfaction

    Measured: 48 hours post-operatively

  13. time to first request of analgesia

    the time for the first patient for analgesia will be noted

    Measured: 48 hours post-operatively

  14. Patient agitation- sedation status post-operatively (PACU)

    Patient status will be monitored using Richmond Agitation Sedation Scale (RASS) on arrival at PACU. This scale can range from -5 (unarousable) to +4 (combative) and 0 means alert and calm

    Measured: Immediately post-operatively

  15. Patient agitation- sedation status in the first 6 hours

    Patient status will be monitored using Richmond Agitation Sedation Scale (RASS) 6 hours post-operatively. This scale can range from -5 (unarousable) to +4 (combative) and 0 means alert and calm

    Measured: 6 hours post-operatively

  16. Patient agitation- sedation status in the first 12 hours

    Patient status will be monitored using Richmond Agitation Sedation Scale (RASS) 12 hours postoperatively. This scale can range from -5 (unarousable) to +4 (combative) and 0 means alert and calm

    Measured: 12 hours post-operatively

  17. Patient agitation- sedation status in the first 24 hours

    Patient status will be monitored using Richmond Agitation Sedation Scale (RASS) 24 hours postoperatively. This scale can range from -5 (unarousable) to +4 (combative) and 0 means alert and calm

    Measured: 24 hours post-operatively

  18. Patient agitation- sedation status in the first 48 hours

    Patient status will be monitored using Richmond Agitation Sedation Scale (RASS) 48 hours postoperatively. This scale can range from -5 (unarousable) to +4 (combative) and 0 means alert and calm

    Measured: 48 hours post-operatively

  19. Nausea and vomiting

    Incidence of nausea and vomiting will be monitored for the first 24 hours postoperatively

    Measured: 24 hours post-operatively

  20. Chronic pain 3 months after operation

    Incidence of chronic pain using douleur neuropathique 4 (DN4) pain scale 3 months after the operation. This scale can range from 0 to 10 and 10 means a worse outcome.

    Measured: 3 months post-operatively

  21. Chronic pain 6 months after operation

    Incidence of chronic pain using douleur neuropathique 4 (DN4) pain scale 6 months after the operation. This scale can range from 0 to 10 and 10 means a worse outcome.

    Measured: 6 months post-operatively

  22. Post-operative cognitive disorder (POCD)

    Incidence of POCD will be assessed using Mini-Mental State Examination (MMSE) pre-operatively and 48 hours post-operatively

    Measured: 48hours post-operatively

  23. Post-operative Delirium (POD) Incidence

    Incidence of POD will be assessed

    Measured: 48 hours post-operatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 May 2023
  2. Study start1 May 2023 (estimated)
  3. Primary completion1 May 2025 (estimated)
  4. Study completion1 May 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
90 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05843344
Sponsor's protocol ID
492/15-03-2023
Status last verified
May 2023
First submitted
12 Apr 2023
Last updated
6 May 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008 Jun;26(2):355-67, vii. doi: 10.1016/j.anclin.2008.01.007.

    PubMed 18456219
  • A Mesbah, MB BCh FCAI FRCA, J Yeung, MB ChB FRCA PhD FFICM, F Gao, MB BS PhD MPhil FRCA MD FFICM, Pain after thoracotomy, BJA Education, Volume 16, Issue 1, January 2016, Pages 1-7, https://doi.org/10.1093/bjaceaccp/mkv005

  • Mazo V, Sabate S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014 Aug;121(2):219-31. doi: 10.1097/ALN.0000000000000334.

    PubMed 24901240
  • Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016 Feb 21;2(2):CD009121. doi: 10.1002/14651858.CD009121.pub2.

    PubMed 26897642
  • Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.

    PubMed 27501016
  • Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andres J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019 Jun;72(3):209-220. doi: 10.4097/kja.d.19.00012. Epub 2019 Mar 19.

    PubMed 30886130
  • Hassan ME, Wadod MAA. Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study. Indian J Anaesth. 2022 Feb;66(2):119-125. doi: 10.4103/ija.ija_257_21. Epub 2022 Feb 24.

    PubMed 35359482
  • Hamed MA, Fargaly OS, Abdelghaffar RA, Moussa MA, Algyar MF. The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study. BMC Anesthesiol. 2023 Feb 15;23(1):53. doi: 10.1186/s12871-023-02014-2.

    PubMed 36793000
  • Gao Z, Xiao Y, Wang Q, Li Y. Comparison of dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial. Ann Transl Med. 2019 Nov;7(22):668. doi: 10.21037/atm.2019.10.74.

    PubMed 31930069
  • Ling L, Yang TX, Lee SWK. Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis. Cureus. 2022 Oct 10;14(10):e30120. doi: 10.7759/cureus.30120. eCollection 2022 Oct.

    PubMed 36381936
  • Suraarunsumrit P, Pathonsmith C, Srinonprasert V, Sangarunakul N, Jiraphorncharas C, Siriussawakul A. Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country. BMC Geriatr. 2022 Mar 16;22(1):213. doi: 10.1186/s12877-022-02873-3.

    PubMed 35296258

Questions about this trial

What is this clinical trial studying?

A study testing erector spinae plane block with a combination of ropivacaine and morphine, erector spinae plane block with a combination of ropivacaine and dexmedetomidine and erector spinae plane block with ropivacaine only in people with Pain, Postoperative and Pain, Acute, run by Dr Kassiani Theodoraki at 2 sites in Greece.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 May 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Greece. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Kassiani Theodoraki, PhD DESA (+306974634162, ktheodoraki@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intravenous morphine consumption in the first 48 hours post-operatively (time frame: 48 hours post-operatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05843344, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2023.

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