Analgesic Effect of Ketamine in Patients Undergoing Hysteroscopic Endometrial Thermal Ablation Surgery

Study Overview
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Brief Summary
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Hypothesis: The intraoperative administration of ketamine will result in a 30% reduction in opiate requirement following endometrial ablation surgery and the intraoperative administration of ketamine will result in a decreased time to meet discharge criteria in the PACU following endometrial ablation surgery. The research question is Does intraoperative administration of ketamine result in decreased postoperative opiate requirement and time to discharge from the postanesthesia recovery unit (PACU) following hysteroscopic endometrial ablation.

Detailed Description
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Preoperatively: Subjects will be recruited up to 21days prior to the day of surgery. After informed consent is obtained, subjects will be randomly assigned to one of two groups: Group A: Saline group Group B: 1% Ketamine group A verbal rating scale (VRS) will be used to assess pain preoperatively. The patient will be asked to identify the severity of pain by indicating on a scale of 0-10 where 0 is no pain and 10 is the worst pain imaginable. Baseline Quality of Recovery will be obtained. (Appendix F) Subjects will be randomized prior to surgery to either Group A or Group B. The randomization table is computer generated. There is a 50% allocation to each group. Intraoperatively: Standard anesthetic monitoring will be used including monitoring of processed EEG including either the bi-spectral index (BIS) or similar standard of care ASA monitor. A standardized intraoperative anesthetic plan will be utilized by the anesthesia personnel. (Appendix A). Study drug will be prepared and labeled in 10mL syringes by research personnel who will not be involved in the study assessments. Study drug will be administered on initial insertion of Novasure® device (Appendix B). Postoperatively: Pain scores in the PACU will be assessed using the VRS upon admission and every 30 minutes thereafter until discharge criteria are met. Additionally, nausea, vomiting and retching episodes will be recorded using a VRS. Postoperative analgesic and antiemetic therapy will be standardized and total amounts of these agents will be recorded Assessment of psychomimetic effects including sedation and agitation will be assess postoperatively prior to discharge using the Richmond Agitation/Sedation Scale (Appendix D). Acute recovery will be assessed using the Modified Post Anesthesia Discharge Scoring System (MPADSS) (Appendix E). A score of 8 or greater will indicate discharge readiness. Time to fulfill discharge criteria will be recorded. Any other adverse events and medications required will be recorded. These data will be recorded by research personnel who will be blinded to the study group assignments. Subjects will be contacted by telephone 24 hours after surgery to assess post-discharge quality of recovery (Appendix F).

Official Title
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Analgesic Effect of Ketamine in Patients Undergoing Hysteroscopic Endometrial Thermal Ablation Surgery

Conditions
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Pain

Intervention / Treatment
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* Drug: Group A: Saline Group
* Drug: Group B: 1% Ketamine group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Gender: Female Age: 18-65 years Non-pregnant, non-lactating Surgery: Outpatient hysteroscopic Novasure® endometrial ablation Language: English speaking Consent: Obtained Exclusion Criteria: Patient refusal Under 18 or over age 65 Non-English Speaking Pregnancy, Breast feeding Hysteroscopic procedures using Thermachoice® ablation device Chronic use or addiction to opiates, sedatives, non-opiate analgesics History of heavy alcohol usage (>4 drinks/day) Significant cardiovascular or pulmonary disease Psychiatric or emotional disorder Allergy to anesthetic agents utilized in the protocol Glaucoma Thyrotoxicosis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Group A: Saline group<br>Group A: Saline group , infusion of saline intravenously | Drug: Group A: Saline Group<br>* Saline continuous infusion<br>* Other names: Saline;|
| Active Comparator: Group B: 1% Ketamine group<br>Group B: Infusion of ketamine 1% intravenously | Drug: Group B: 1% Ketamine group<br>* Administration of 1% ketamine intravenously.<br>* Other names: Ketamine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Recovery Score Post Operative at 24 Hours | Quality of recovery 40 score at 24 hours after the surgical procedure. 40 being a poor recovery and 200 being a good recovery. | 24 hours post operative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ketamine, Anesthesia, Pain, Outpatient surgery