Clinical trial NCT04859283: Premedication with Intranasal Dexmedetomidine in Sedation of Patients Undergoing Total Knee Arthroplasty
Official title: Premedication with Intranasal Dexmedetomidine in Sedation of Patients Undergoing Total Knee Arthroplasty
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Knee Osteoarthritis
Pain, Postoperative
Keywords: intranasal
dexmedetomidine
multimodal analgesia
Lead sponsor: Turku University Hospital
Sponsor class: OTHER_GOV
First posted: 2021-04-26
Enrollment: 100
Sex: ALL
Minimum age (years): 35
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study aims to find out if preoperatively given dexmedetomidine is effective analgesic adjuvant for treating postoperative pain in patients undergoing elective total knee arthroplasty (TKA). Another aim is to determine if premedication with intranasal dexmedetomidine could provide sufficient sedation to alleviate anxiety during TKA.

Detailed description: Patients undergoing total knee arthroplasty (TKA) under spinal anesthesia often request sedation to alleviate anxiety. Dexmedetomidine may be ideally suited to provide sedation during surgery as it offers sedation and analgesia without causing significant respiratory depression. Furthermore, dexmedetomidine has beneficial synergistic interactions with opioids and sedative drugs.

Altogether 80 patients scheduled for elective unilateral TKA under spinal anesthesia will be included in the prospective, randomized and controlled parallel-group study. Patients will be randomized into two groups, forty patients in each group. All patients will receive preoperatively 1000 mg of oral paracetamol as premedication. One group receives a single bolus dose of intranasal 1 ug/kg dexmedetomidine (DEX group) and the other group receives euvolemic dose (10 µL/kg) of saline (PLACEBO-group).

Spinal anesthesia will be performed using bupivacaine (5 mg/mL) using 2.0-2.5 mL dose, the amount depending on the clinical judgement of the anesthesiologist responsible for the patient. If patient needs additional analgesic after spinal anesthesia, 50 µg dose of intravenous fentanyl or 3-5 mg of intravenous midazolam may be administered intraoperatively.

Postoperative pain management in the surgical ward includes oral paracetamol 1000 mg every 8 hours, and from the first postoperative day onwards patients receive oral naproxen/esomeprazole 500/20 mg twice a day. Oral oxycodone (5-10 mg) will be used, if the pain (measured with numerical rating scale, NRS, min 0, max 100, higher scores mean worse outcome) is moderate or intense (NRS\>30) after paracetamol and naproxen.

Postoperative pain (NRS) and opioid consumption (mg) will be measured and analysed together with intraoperative sedative used (mg, midazolam and/or fentanyl allowed).

Eligibility criteria: Inclusion Criteria:

1. The patient is scheduled for elective unilateral total knee arthroplasty (TKA) under spinal anesthesia
2. Fluent skills in finnish language (to understand the given information and to be able to give informed consent and communicate with the study personnel)
3. Age between 35 and 80 years
4. Weight between 50 and 100 kg
5. American Society of Anesthesiologists status 1-3
6. Written informed consent from the patient

Exclusion Criteria:

1. A previous history of intolerance to the study drug or related compounds and additives
2. Disease or condition affecting patient's ability to give written informed consent
3. Existing or recent disease possible affecting absorption, distribution, metabolism, excretion or response to the study drug
4. History of severe cardiac disease (valvular insufficiency, severe left ventricular dysfunction) or abnormal ECG rhythm (bradycardia \< 50/min, 2nd or 3rd degree atrioventricular-block, pacemaker)
5. Preoperative systolic blood pressure \<110 mmHg
6. Chronic use of strong opioids, pregabalin, gabapentin, amitriptyline or duloxetine
7. Participation in any other study concomitantly or within one month prior to the entry into this study
8. Clinically significant abnormal findings in physical examination or laboratory screening
9. Pregnancy or breastfeeding
10. Use of any drugs known to cause enzyme induction or inhibition for a period of 30 days prior to the study, use of any natural products (including grapefruit products) for at least 14 days prior to the study and caffeine containing products for at least 24 hours prior to the study. The use of regular doses of paracetamol is allowed.

Primary outcomes:
measure: Change in numerical rating scale (NRS 0-100 mm, min 0, max 100, higher score means worse outcome)
timeFrame: 24 hours
measure: Change in intraoperative sedatives (mg) administered
timeFrame: From anesthesia induction to the end of surgery.
measure: Change in opioid consumption (mg) postoperatively
timeFrame: 24 hours
Secondary outcomes:
measure: Change (mmHg) in hemodynamic parameter (blood pressure)
timeFrame: 24 hours
measure: Change (%) in respiratory parameter (peripheral oxygen saturation, SpO2)
timeFrame: 24 hours
measure: Number of patients with adverse events as a measure of safety and tolerability
timeFrame: 24 hours
Other outcomes:
Locations:
city: Turku
country: Finland
facility: Perioperative Services, Intensive Care and Pain Therapy, Turku University Hospital and University of Turku
Study officials:
affiliation: Turku University Hospital, University of Turku
name: Suvi-Maria Tiainen, MD
role: PRINCIPAL_INVESTIGATOR
References: