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Hiatal HerniaNCT05953428

Reducing Postoperative Opioids in Patients Undergoing Laparoscopic Hiatal Hernia

A study testing Opioid Sparing Anesthesia Protocol (OSA) and Opioid Based Anesthesia Protocol (OBA) in people with Hiatal Hernia, run by Endeavor Health at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a prospective randomized, double-blinded, controlled trial that will target enrollment of 46 subjects undergoing laparoscopic hiatal hernia repair surgery. Participants who meet eligibility criteria will be randomized in a 1:1 ratio to receive either the opioid sparring anesthesia protocol (OSA) or the opioid… Read more about this study

Who is it for?
Ages 18 to 90 yearsHealthy volunteers can take part
Conditions the study is for
Hiatal Hernia
What is being tested?
Opioid Sparing Anesthesia Protocol (OSA) and Opioid Based Anesthesia Protocol (OBA)
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteUnited States
Study dates
3 Mar 2024to 30 Apr 2026
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 18 to 90 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients from 18-90 years old who are undergoing laparoscopic hiatal hernia surgery
  • Elective Laparoscopic hiatal hernia repair

Who cannot join

  • Patients receiving urgent or emergent hiatal hernia surgery
  • Patients receiving hiatal hernia surgery without laparoscopy
  • Patients with adverse reactions (e.g., anaphylaxis, rash) to any of the drugs in the OBA or OSA protocols.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Endeavor Health

    Evanston, Illinois, 60201

Other trials in United States

About this study

This is a prospective randomized, double-blinded, controlled trial that will target enrollment of 46 subjects undergoing laparoscopic hiatal hernia repair surgery. Participants who meet eligibility criteria will be randomized in a 1:1 ratio to receive either the opioid sparring anesthesia protocol (OSA) or the opioid based anesthesia protocol (OBA). The purpose of this study is to investigate if an opioid sparring protocol for laparoscopic hiatal hernia repair will reduce opioid consumption during discharge. Other outcomes include: postoperative VAS scores (PACU arrival, PACU discharge, hospital discharge), total in hospital opioid consumption, PACU length of stay, incidence of postoperative nausea and vomiting (PONV in PACU, postoperative day 1, during hospital stay), rehospitalization rate, rate of reoperation, rate of emergency room visit, surgeon satisfaction, and hospital cost differential.

Read the detailed description

The administration of perioperative opioids to nearly 80% of surgical patients leaves approximately 6 million Americans susceptible to becoming opioid-dependent. This practice has been hypothesized as a contributing factor to the ongoing opioid crisis, where currently more than 136 Americans die from an opioid overdose every day. Recent data suggest a potential benefit of reducing perioperative opioid use, while improving the quality of surgical recovery when employing an Opioid Sparing Anesthesia (OSA) protocol with non-narcotic analgesics.

More than a million hernia repairs are performed each year in the US. With the significant nationwide obesity epidemic, it is estimated that the prevalence of hiatal hernias in the western population is approximately 20%. The investigators perform hundreds of laparoscopic hiatal hernia repairs annually at NorthShore University HealthSystem. Patients routinely receive fentanyl and other opioids during this surgery to reduce pain, but opioids also increase the risk of nausea, vomiting, and ileus. In addition, these patients are often times prescribed opioids upon discharge from the hospital. Preliminary results from a small, retrospective study among laparoscopic hiatal hernia surgical patients suggested that an OSA protocol with non-narcotic analgesics (that included dexmedetomidine and ketamine) resulted in a 33% reduction in those patients requiring opioids post-discharge. Moreover, these same patients had a significant reduction in hospital length of stay and nausea/retching. Therefore, the investigators propose a double-blinded randomized controlled trial to compare the number of patients in OSA protocol vs. Opioid Based Anesthesia (OBA) protocol groups, who require no opioids within 7 days postoperatively, (a time period where our quality data suggest nearly all patients receive postoperative opioids in this population).

Conditions
Hiatal Hernia
Being tested
Opioid Sparing Anesthesia Protocol (OSA), Opioid Based Anesthesia Protocol (OBA)
Keywords
Opioid Sparing Anesthesia Protocol, Opioid Based Anesthesia Protocol
Medical subject headings
Hernia, Hiatal

What participants receive

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

  • Opioid Sparing Anesthesia Protocol (OSA)Other

    OSA protocol will include boluses of dexmedetomidine and ketamine at anesthesia induction, followed by a ketamine infusion that will continue until PACU discharge. Another bolus of ketamine will be administered upon surgical incision and another dexmedetomidine bolus will be given at surgical closure to reduce the use of opioids.

  • Opioid Based Anesthesia Protocol (OBA)Other

    The OBA group will be administered a saline infusion at the same rate of the ketamine infusion (only while in the PACU) up until PACU discharge so that surgeons, patients, and PACU nurses will be blinded. The OBA group will be administered fentanyl 100 mcg IV for anesthesia induction followed by 50 mcg IV boluses when heart rate or systolic blood pressure is 20% above baseline throughout the case.

Study groups in NCT05953428
Study groupRoleWhat they receive
Opioid Sparing Anesthesia ProtocolExperimentalThe OSA protocol will include boluses of dexmedetomidine and ketamine at anesthesia induction, followed by a ketamine infusion that will continue until PACU discharge. Another bolus of ketamine will be administered upon surgical incision and another dexmedetomidine bolus will be given at surgical closure to reduce the use of opioids.
Receives: Other: Opioid Sparing Anesthesia Protocol (OSA)
Opioid Based Anesthesia ProtocolOtherThe OBA group will be administered a saline infusion at the same rate of the ketamine infusion (only while in the PACU) up until PACU discharge so that surgeons, patients, and PACU nurses will be blinded. The OBA group will be administered fentanyl 100 mcg IV for anesthesia induction followed by 50 mcg IV boluses when heart rate or systolic blood pressure is 20% above baseline throughout the case.
Receives: Other: Opioid Based Anesthesia Protocol (OBA)

What is being measured

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

  1. The Difference in Discharge Opioid Consumption in Morphine Milligram Equivalents (MMEs)

    The difference in discharge opioid consumption in morphine milligram equivalents (MMEs) from postoperative day 1 through postoperative day 7 in patients in the Opioid Sparing Anesthesia (OSA) protocol vs. Opioid Based Anesthesia (OBA) protocol will be collected.

    Measured: Postoperative day 1,2, 3, 4, 5, 6 and 7.

Secondary outcomes (11)
  1. Postoperative Visual Analogue Scale (VAS) Pain Scores

    Patients Visual Analogue Scale (VAS) pain scores in each group will be collected. Subjects will rate their pain level on a scale of 0-10 cm. Number "0" indicates no pain and number "10" indicates terrible pain.

    Measured: Upon post-anesthesia care unit (PACU) arrival (within 2 hours after surgery), upon PACU discharge (4 hours after surgery), at hospital discharge, and on postoperative day 1, 2, 3, 4, 5, 6, and 7.

  2. Postoperative Hospital Opioid Consumption (MMEs)

    Total hospital opioid consumption (MMEs) in each group will be collected starting from the end of surgery (PACU admission) until hospital discharge or on postoperative day 7, whichever is first.

    Measured: From PACU admission until hospital discharge, up to 7 days after admission

  3. Post Anesthesia Care Unit

    Post anesthesia care unit (PACU) length of stay (hours) in each group will be recorded.

    Measured: from PACU admission until PACU discharge

  4. Hospital Length of Stay

    Hospital length of stay (hours) in each group will be recorded.

    Measured: from hospital admission for hernia surgery until hospital discharge

  5. Incidence of Post Operative Nausea and Vomiting (PONV )

    Incidence of post operative nausea and vomiting in each group will be recorded.

    Measured: during post anesthesia care unit stay (up to 3 hours), postoperative Day 1, during hospital stay (up to 7 days)

  6. Rate of Rehospitalization

    Rate of rehospitalization will be recorded for each group up to 30 days after hiatal hernia surgery.

    Measured: within 30 days of surgery

  7. Rate of Reoperation

    Rate of reoperation will be recorded for each group up to 30 days after hiatal hernia surgery.

    Measured: within 30 days of surgery

  8. Rate of Emergency Room Visit

    Rate of emergency room visits will be recorded up to 30 days after hiatal hernia surgery.

    Measured: within 30 days of surgery

  9. Surgeon Satisfaction With Surgical Conditions

    Surgeon satisfaction with surgical conditions using a 5-point Likert score will be collected after surgery. A scale from 1-5; 1=Very dissatisfied, 2=Somewhat dissatisfied, 3=Neutral, 4=Somewhat satisfied, 5=Very satisfied)

    Measured: within 30 minutes after surgery

  10. VAS Pain Severity Postoperative Days 1-7

    VAS Pain Severity was calculated for Postoperative Days 1-7. VAS scores of 0-3 were classified as mild, scores of 4-6 were classified as moderate, and scores of 7-10 were classified as severe.

    Measured: Postoperative days 1, 2, 3, 4, 5, 6, 7.

  11. Total Ketorolac Dose

    Total Ketorolac dose administered intraoperatively and postoperatively until hospital discharge

    Measured: From hospital admission until hospital discharge

Timeline

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

  1. First posted20 Jul 2023
  2. Study start3 Mar 2024
  3. Primary completion23 Jan 2026
  4. Study completion30 Apr 2026

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
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients undergoing laparoscopic hiatal hernia repairs will be randomized to: Experimental Group: Opioid Sparing Anesthesia Protocol vs. Control Group: Opioid Based Anesthesia Protocol
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05953428
Sponsor's protocol ID
EH23-020
Status last verified
Aug 2026
First submitted
5 Jul 2023
Last updated
13 Aug 2026
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lawal OD, Gold J, Murthy A, Ruchi R, Bavry E, Hume AL, Lewkowitz AK, Brothers T, Wen X. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Jun 1;3(6):e207367. doi: 10.1001/jamanetworkopen.2020.7367.

    PubMed 32584407
  • Bastawrous AL, Brockhaus KK, Chang MI, Milky G, Shih IF, Li Y, Cleary RK. A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use. Surg Endosc. 2022 Jan;36(1):701-710. doi: 10.1007/s00464-021-08338-9. Epub 2021 Feb 10.

    PubMed 33569727
  • Siu EY, Moon TS. Opioid-free and opioid-sparing anesthesia. Int Anesthesiol Clin. 2020 Spring;58(2):34-41. doi: 10.1097/AIA.0000000000000270. No abstract available.

    PubMed 32004171
  • Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, Salihoglu Z. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol. 2015 May-Jun;65(3):191-9. doi: 10.1016/j.bjane.2014.05.001. Epub 2014 Jun 3.

    PubMed 25925031
  • Hoffman C, Buddha M, Mai M, Sanjeevi S, Gutierrez R, O' Neill C, Miller A, Banki F. Opioid-Free Anesthesia and Same-Day Surgery Laparoscopic Hiatal Hernia Repair. J Am Coll Surg. 2022 Jul 1;235(1):86-98. doi: 10.1097/XCS.0000000000000229. Epub 2022 Apr 11.

    PubMed 35703966
  • Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage. 2001 May;21(5):397-406. doi: 10.1016/s0885-3924(01)00271-8.

    PubMed 11369161
  • Wengritzky R, Mettho T, Myles PS, Burke J, Kakos A. Development and validation of a postoperative nausea and vomiting intensity scale. Br J Anaesth. 2010 Feb;104(2):158-66. doi: 10.1093/bja/aep370. Epub 2009 Dec 26.

    PubMed 20037151

Questions about this trial

What is this clinical trial studying?

A study testing Opioid Sparing Anesthesia Protocol (OSA) and Opioid Based Anesthesia Protocol (OBA) in people with Hiatal Hernia, run by Endeavor Health at 1 site in United States.

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 2 inclusion and 3 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: finished, as of the sponsor's last update on 13 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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?

Yes. Results are posted in the registry (first posted 13 Aug 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Difference in Discharge Opioid Consumption in Morphine Milligram Equivalents (MMEs) (time frame: Postoperative day 1,2, 3, 4, 5, 6 and 7.). 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 NCT05953428, which also lists 7 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 13 Aug 2026.

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