Abdominal Cancer SurgeryPhase 4NCT06695468
Efficacy and Safety of Adding Dexmedetomidine to Levobupivacaine in Rectus Sheath Block Compared to Quadratus Lumborum Block in Patients Undergoing Lower Abdominal Cancer Surgery: A Randomized Clinical Trial
A Phase 4 study testing Levobupivacaine and Levobupivacaine + Dexmedetomidine in people with Abdominal Cancer Surgery, run by Assiut University.
Trial summary
Surgical trauma activates numerous receptors leading to severe postoperative pain. Seventy to seventy-five percent of the pain is somatic, originating from the anterior abdominal wall, and it often persists for 72 hours after open surgery. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Abdominal Cancer Surgery
- What is being tested?
- Levobupivacaine and Levobupivacaine + Dexmedetomidine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 122 participants
- Where
- No sites listed yet
- Study dates
- 1 Dec 2024to 1 Jan 2027
- Phase
- Phase 4
- Are there results?
- Not yet: the study is under way
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients subjected to major lower abdominal cancer surgeries.
- The enrolled age will be from 18 years to 70 years
- ASA I-III and NYHA I-III.
Who cannot join
- ASA physical status >III and NYHA>III
- Patient refusal
- Body mass index >40 kg/m2
- Preoperative opioid consumption
- Infection at the incision site
- A history of hematological disorders or coagulation abnormality
Show all 9Show fewer
- Previous abdominal surgeries, severe hepatic or renal impairment
- Pregnant women
- 10- Hypersensitivity to any of used drugs
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Surgical trauma activates numerous receptors leading to severe postoperative pain. Seventy to seventy-five percent of the pain is somatic, originating from the anterior abdominal wall, and it often persists for 72 hours after open surgery. The objective of this study is to compare the efficacy and safety of adding dexmedetomidine to Levobupivacaine in rectus sheath block with quadrates lumborum block in patients undergoing lower abdominal cancer surgeries.
Read the detailed description
Postoperative pain may cause tachycardia, hypertension, increased cardiac work, nausea, vomiting and ileus. Also, if it is inadequately managed it may lead to hazardous cardiovascular effects, pulmonary dysfunction, immune system, neuro-endocrine and metabolic effects, gastrointestinal- urinary- and cognitive dysfunction and also have psychological, economic and social adverse effects. Therefore, effective pain management is a priority of care and a patient's right.
The American Society of Anesthesiologists recommends use of multimodal pain regimens to minimize opioid use and improve pain control . Opioids are still the go-to medication for treating visceral pain, but they are ineffective against somatic discomfort. An effective Multimodal pain management protocol uses combinations of opioid prescriptions, nonopioid prescription, regional and local anesthesia, and nonpharmacological therapy . To mitigate the adverse consequences of opioid overconsumption, peripheral and regional anesthetic blocks were implemented. The Quadratus lumborum block is one of the perioperative pain management procedures that is administered to patients of all ages who are undergoing abdominal surgery . Nevertheless, there is persistent disagreement regarding the optimal method of administering the block due to the ambiguous mechanisms that are responsible for its effects.
We sought an alternative, such as the Rectus sheath block, to prevent postoperative somatic pain, due to the potential complications of the QLB technique, including retroperitoneal hemorrhage, abscess, and pleural injury . The block was not frequently applied, or insufficient blocks could not be achieved primarily with a single injection method prior to taking advantage of ultrasonography. This was due to the proximity of medicated zones and vital organs, as well as the coherent and thin muscle layers. Currently, this approach is being implemented with catheter placement in the rectus sheath, ultrasonography guidance, and a single injection .
At present, several adjuvants have been added to local anesthetics used in peripheral and regional blocks to decrease the dosage of local anesthetic and enhance its effectiveness . Dexmedetomidine is an adjuvant that acts as a selective alpha two adrenoreceptor stimulating agent. This medication induces drowsiness, analgesia, sympatholysis, and anxiolysis in a dose-dependent manner, without causing significant respiratory depression.
- Conditions
- Abdominal Cancer Surgery
- Being tested
- Levobupivacaine, Levobupivacaine + Dexmedetomidine
- Keywords
- Quadratus Lumborum Block, dexmedetomidine, Levobupivacaine, Rectus sheath block
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
LevobupivacaineDrug
40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side
Levobupivacaine + DexmedetomidineDrug
60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment).
| Study group | Role | What they receive |
|---|---|---|
| Quadratus lumborum block (QLB group) | Experimental | patients will receive bilateral QLB with a 40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side). Receives: Drug: Levobupivacaine |
| Rectus sheath block (RSB group) | Experimental | patients will receive bilateral RSB with a 60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment). Receives: Drug: Levobupivacaine + Dexmedetomidine |
What is being measured
The primary outcome is the main question the study is designed to answer.
pain intensity
measured by VAS immediately postoperatively, then at 2-, 4-, 6-, 8-, 12-, 18-, 24-hours after surgery.
Measured: 24 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Nov 2024
- Study start1 Dec 2024 (estimated)
- Primary completion1 Dec 2026 (estimated)
- Study completion1 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Abdominal Cancer SurgeryStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 122 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Kerollos Ibrahim Gayed Ibrahim, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06695468
- Sponsor's protocol ID
- dexmedetomidine QLB
- Status last verified
- Nov 2024
- First submitted
- 17 Nov 2024
- Last updated
- 19 Nov 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Zheng Y, Cui S, Liu Y, Zhang J, Zhang W, Zhang J, Gu X, Ma Z. Dexmedetomidine prevents remifentanil-induced postoperative hyperalgesia and decreases spinal tyrosine phosphorylation of N-methyl-d-aspartate receptor 2B subunit. Brain Res Bull. 2012 Mar 10;87(4-5):427-31. doi: 10.1016/j.brainresbull.2012.01.009. Epub 2012 Jan 25.
PubMed 22301064Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004 Oct;101(4):950-9. doi: 10.1097/00000542-200410000-00021.
PubMed 15448529Okmen K, Metin Okmen B, Topal S. Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study. J Clin Anesth. 2018 Sep;49:112-117. doi: 10.1016/j.jclinane.2018.06.027. Epub 2018 Jun 18.
PubMed 29929169
Study at a glance
From the registry record, last updated by the sponsor on 19 Nov 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Efficacy and Safety of Adding Dexmedetomidine to Levobupivacaine in Rectus Sheath Block Compared to Quadratus Lumborum Block in Patients Undergoing Lower Abdominal Cancer Surgery: A Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT06695468
- Acronym / sponsor ID
- dexmedetomidine QLB
- Conditions
- Abdominal Cancer Surgery
- Keywords
- Quadratus Lumborum Block, dexmedetomidine, Levobupivacaine, Rectus sheath block
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 122 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Dec 2024 (estimated)
- Primary completion
- 1 Dec 2026 (estimated)
- Study completion
- 1 Jan 2027 (estimated)
- First posted
- 19 Nov 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Surgical trauma activates numerous receptors leading to severe postoperative pain. Seventy to seventy-five percent of the pain is somatic, originating from the anterior abdominal wall, and it often persists for 72 hours after open surgery. The objective of this study is to compare the efficacy and safety of adding dexmedetomidine to Levobupivacaine in rectus sheath block with quadrates lumborum block in patients undergoing lower abdominal cancer surgeries.
Detailed description
Postoperative pain may cause tachycardia, hypertension, increased cardiac work, nausea, vomiting and ileus. Also, if it is inadequately managed it may lead to hazardous cardiovascular effects, pulmonary dysfunction, immune system, neuro-endocrine and metabolic effects, gastrointestinal- urinary- and cognitive dysfunction and also have psychological, economic and social adverse effects. Therefore, effective pain management is a priority of care and a patient's right.
The American Society of Anesthesiologists recommends use of multimodal pain regimens to minimize opioid use and improve pain control . Opioids are still the go-to medication for treating visceral pain, but they are ineffective against somatic discomfort. An effective Multimodal pain management protocol uses combinations of opioid prescriptions, nonopioid prescription, regional and local anesthesia, and nonpharmacological therapy . To mitigate the adverse consequences of opioid overconsumption, peripheral and regional anesthetic blocks were implemented. The Quadratus lumborum block is one of the perioperative pain management procedures that is administered to patients of all ages who are undergoing abdominal surgery . Nevertheless, there is persistent disagreement regarding the optimal method of administering the block due to the ambiguous mechanisms that are responsible for its effects.
We sought an alternative, such as the Rectus sheath block, to prevent postoperative somatic pain, due to the potential complications of the QLB technique, including retroperitoneal hemorrhage, abscess, and pleural injury . The block was not frequently applied, or insufficient blocks could not be achieved primarily with a single injection method prior to taking advantage of ultrasonography. This was due to the proximity of medicated zones and vital organs, as well as the coherent and thin muscle layers. Currently, this approach is being implemented with catheter placement in the rectus sheath, ultrasonography guidance, and a single injection .
At present, several adjuvants have been added to local anesthetics used in peripheral and regional blocks to decrease the dosage of local anesthetic and enhance its effectiveness . Dexmedetomidine is an adjuvant that acts as a selective alpha two adrenoreceptor stimulating agent. This medication induces drowsiness, analgesia, sympatholysis, and anxiolysis in a dose-dependent manner, without causing significant respiratory depression.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Quadratus lumborum block (QLB group) | Experimental | Drug: Levobupivacainepatients will receive bilateral QLB with a 40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side). |
| Rectus sheath block (RSB group) | Experimental | Drug: Levobupivacaine + Dexmedetomidinepatients will receive bilateral RSB with a 60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Patients subjected to major lower abdominal cancer surgeries.
- The enrolled age will be from 18 years to 70 years
- ASA I-III and NYHA I-III.
Key exclusion criteria (9 listed)
- ASA physical status >III and NYHA>III
- Patient refusal
- Body mass index >40 kg/m2
- Preoperative opioid consumption
- Infection at the incision site
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Levobupivacaine40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side | Drug | Quadratus lumborum block (QLB group) |
| Levobupivacaine + Dexmedetomidine60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment). | Drug | Rectus sheath block (RSB group) |
Primary outcome
pain intensity
Time frame: 24 hours
measured by VAS immediately postoperatively, then at 2-, 4-, 6-, 8-, 12-, 18-, 24-hours after surgery.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Nov 2024.
- Results publication: PubMed 22301064Zheng Y, Cui S, Liu Y, Zhang J, Zhang W, Zhang J, Gu X, Ma Z. Dexmedetomidine prevents remifentanil-induced postoperative hyperalgesia and decreases spinal tyrosine phosphorylation of N-methyl-d-aspartate receptor 2B subunit. Brain Res Bull. 2012 Mar 10;87(4-5):427-31. doi: 10.1016/j.brainresbull.2012.01.009. Epub 2012 Jan 25.
- Results publication: PubMed 15448529Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004 Oct;101(4):950-9. doi: 10.1097/00000542-200410000-00021.
- Results publication: PubMed 29929169Okmen K, Metin Okmen B, Topal S. Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study. J Clin Anesth. 2018 Sep;49:112-117. doi: 10.1016/j.jclinane.2018.06.027. Epub 2018 Jun 18.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Levobupivacaine and Levobupivacaine + Dexmedetomidine in people with Abdominal Cancer Surgery, run by Assiut University.
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 3 inclusion and 9 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: opening soon, as of the sponsor's last update on 19 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.
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.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Kerollos Ibrahim Gayed Ibrahim, resident doctor (+201282351859, Cerles.16266305@med.aun.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
pain intensity (time frame: 24 hours). 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 NCT06695468, which also lists 3 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 19 Nov 2024.