Clinical trial NCT05732064: Dexmedetomidine-esketamine Combined Nasal Administration and Perioperative Sleep Quality
Official title: Effects of Low-dose Dexmedetomidine-esketamine Combined Nasal Administration at Night on Perioperative Sleep Quality in Breast Cancer Patients: a Randomized, Double-blind, Placebo-controlled Trial
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE4
Conditions: Breast Cancer
Perioperative Period
Dexmedetomidine
Esketamine
Sleep Quality
Keywords: Breast Cancer
Perioperative period
Dexmedetomidine
Esketamine
Sleep quality
Lead sponsor: Peking University First Hospital
Sponsor class: OTHER
First posted: 2023-02-16
Enrollment: 180
Sex: FEMALE
Minimum age (years): 50
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Breast cancer patients often have sleep disturbances during the perioperative period. Dexmedetomidine is a highly selective alpha 2-adrenoceptor agonist with sedative, anxiolytic, and analgesic effects. Previous studies showed that night-time low-dose dexmedetomidine infusion improved sleep quality. Esketamine is a N-methyl-D-aspartic acid receptor antagonist and has been used as an anesthetic and analgesic. Recent studies showed that low-dose esketamine has anti-depressive and sleep-promoting effects. The investigators suppose that low-dose dexmedetomidine-esketamine combined nasal administration at night can improve perioperative sleep quality in patients scheduled for breast cancer surgery.

Detailed description: Normal sleep is important for maintaining both physical and mental health. Patients who are scheduled for breast cancer surgery often have sleep disturbances during the perioperative period. Patients with persistent sleep disturbances have increased sensitivity to pain and are at increased risk of developing chronic postsurgical pain.

Dexmedetomidine is a highly selective alpha 2-adrenoceptor agonist with sedative, anxiolytic, and analgesic effects. Previous studies showed that night-time low-dose dexmedetomidine infusion improves sleep quality. Nasal administration of dexmedetomidine has been used in children as a premedication and in adults to reduce emergence agitation.

Esketamine is a N-methyl-D-aspartic acid receptor antagonist and has been used as an anesthetic and analgesic. Recent studies showed that low-dose esketamine has anti-depressive and sleep-promoting effects. Nasal administration of esketamine has been used in children to relieve pain and in adults for treatment-resistant depression.

This randomized trial is designed to test the hypothesis that combined nasal administration of low-dose dexmedetomidine-esketamine at night can improve perioperative sleep quality in patients scheduled for breast cancer surgery.

Eligibility criteria: Inclusion Criteria:

* Aged 50 years or older;
* Diagnosed with breast cancer and scheduled for surgical resection;
* Signed the informed consent form.

Exclusion Criteria:

* Not suitable for nasal administration because of nasal cavity diseases (rhinitis, nasal polyps, or nasal membrane congestion by any reason);
* History of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis;
* Unable to communicate due to coma, delirium, severe dementia, or language barrier before surgery;
* History of intracranial injury or neurosurgery;
* Taking sedative/hypnotics for sleep in the last month;
* Preoperative sleep apnea (diagnosed with sleep apnea, or at high risk of sleep apnea according to STOP-Bang assessment);
* History of hyperthyroidism and pheochromocytoma;
* Preoperative LVEF\<30%; sick sinus syndrome, severe sinus bradycardia (heart rate\<50 beats/min), or atrioventricular block of degree II or higher without pacemaker; use vasopressors with systolic blood pressure \<90 mmHg;
* Severe liver dysfunction (Child-Pugh C classification), severe renal dysfunction (dialysis before surgery), or Amercian Society of Anesthesiologists classification ≥IV;
* Allergic to dexmedetomidine and/or esketamine, or other conditions that are considered unsuitable for study participation;
* Body mass index \>30 kg/m2;
* Enrolled in other clinical studies.

Primary outcomes:
measure: Subjective sleep quality (the night of surgery)
timeFrame: The night on the day of surgery
Secondary outcomes:
measure: Subjective sleep quality (the night before and the first night after surgery)
timeFrame: The night before surgery and the first night after surgery
measure: Objective sleep quality - total sleep time
timeFrame: The night before surgery, the night on the day of surgery, and the first night after surgery
measure: Objective sleep quality - sleep efficiency
timeFrame: The night before surgery, the night on the day of surgery, and the first night after surgery
measure: Objective sleep quality - sleep latency
timeFrame: The night before surgery, the night on the day of surgery, and the first night after surgery
measure: Objective sleep quality - wake-up time after falling asleep
timeFrame: The night before surgery, the night on the day of surgery, and the first night after surgery
measure: Intensity of acute pain
timeFrame: At 2 hours after surgery and twice daily during the first 2 postoperative days
measure: Subjective sleep quality at 30 days
timeFrame: At 30 days after surgery
Other outcomes:
measure: Use of supplemental analgesics
timeFrame: Within the first 2 days after surgery
measure: Severity of anxiety
timeFrame: Before hospital discharge
measure: Severity of depression
timeFrame: Before hospital discharge
measure: Length of hospital stay after surgery
timeFrame: Up to 30 days after surgery
measure: Occurrence of postoperative complications
timeFrame: Up to 30 days after surgery
measure: Occurrence of Chronic Postoperative Pain
timeFrame: At 3 months after surgery
measure: Severity of chronic pain
timeFrame: At 3 months after surgery
measure: Interference of chronic pain
timeFrame: At 3 months after surgery
measure: Life quality assessed with the EORTC QLQ-BR53 (part of EORTC-C30)
timeFrame: At 3 months after surgery
measure: Life quality assessed with the EORTC QLQ-BR53 (part of EORTC-BR23)
timeFrame: At 3 months after surgery
Locations:
city: Beijin
country: China
facility: Peking University First Hospital
state: Bejing
Study officials:
affiliation: Peking University First Hospital
name: Dong-Xin Wang, MD, PhD
role: PRINCIPAL_INVESTIGATOR
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