Analgesic Effect of Intraoperative Esmolol in Mastectomies
Information source: Hospital de Base
ClinicalTrials.gov processed this data on August 20, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Postoperative Pain
Intervention: Placebo group (Drug); Esmolol group (Drug)
Phase: Phase 4
Status: Recruiting
Sponsored by: Hospital de Base Official(s) and/or principal investigator(s): Fabricio T Mendonca, MD, TSA, Principal Investigator, Affiliation: Hospital de Base do Distrito Federal
Overall contact: Fabricio T Mendonca, MD, TSA, Phone: +556181882640, Email: fabricio.tavares@me.com
Summary
This study aims to compare the quality of perioperative analgesia of esmolol in patients
undergoing mastectomy.
Clinical Details
Official title: Analgesic Effect of Intraoperative Esmolol in Mastectomies: Single Center, Prospective, Double-blind, Randomized and Placebo Controlled Study
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Prevention
Primary outcome: Pain Scores on the Visual Analogue Scale
Secondary outcome: Pain Scores on the Verbal Rating ScaleAnalgesics consumption in post-operative Analgesic consumption during surgery Number of participants with adverse events as a measure of safety and tolerability Number of participants with adverse events as a measure of safety and tolerability
Detailed description:
Controlled hypotension is an anesthetic-surgical approach that matches the reversible and
deliberate reduction in blood pressure during surgery period which aims to achieve values
below 50% of normal values or mean arterial pressure (MAP) from 50 to 65 mmHg.
This technique is especially beneficial in patients undergoing procedures requiring control
of bleeding for proper surgical field. The method provides a better view of anatomical
structures, reduced surgical time and a significant decrease in the need for blood
transfusions, with the added benefit of preventing possible complications from it.
Several drugs have been used in this scenario, as halogenated, opioids, alpha-2-agonists and
beta-blockers, among which the esmolol emerges as effective and promising drug.
Esmolol is a selective beta-blocker whose action inhibits preferably the beta type 1
receptors with decreased heart rate (HR) and cardiac inotropic and consequent decrease in
consumption of myocardial oxygen. Its half-life of distribution is approximately 2 minutes,
the elimination half-life of 9 minutes with 55% protein bound. The duration is short due to
rapid metabolism by hydrolysis by esterases in plasma and results in an inactive metabolite
with negligible amounts of methanol. It has low solubility, which limits their passage
through the blood-brain and placental barrier. Thanks to these features, the esmolol
constitutes the most appropriate beta-blocker for intravenous use under continuous infusion.
The use of a selective beta-blocking agent continuously infused intraoperative period as
well as promoting adequate blood pressure control in the controlled hypotension, it has
additional advantages over other anesthetic agents, such as cardioprotection obtained by
suppressing the cardiovascular response to catecholamines released during stress surgical
and sympathetic stimulation resulting from laryngoscopy and tracheal intubation. The
suppression of cardiovascular adrenergic response allows better coronary perfusion with
proven benefits in reducing the incidence of perioperative myocardial ischemia and influence
on mortality and morbidity of patients, especially coronary and high risk for ischemic
phenomena. There are also several studies that demonstrate the importance of esmolol in the
control and prevention of sympathetic response during extubation, better hemodynamics during
induction, maintenance and emergence from anesthesia, fewer complications, lower incidence
of perioperative nausea, time decreased from room to stay anesthetic recovery and, due to
reduced cardiac work, action prolongation of neuromuscular blockers and opioids, saving
their use. There are still ongoing studies with important indications that there is
potentiation of analgesia and the hypnotic component of anesthesia with the use of esmolol.
Opioid analgesics are commonly used in clinical practice for the treatment of perioperative
pain. However, many side effects are associated with its use, such as respiratory
depression, nausea, vomiting, drowsiness, itching, urinary retention, constipation,
hyperalgesia and impaired immune function. Therefore, alternative techniques and drugs have
been used to replace their use. In recent years, the use of adjuvant drugs is becoming more
popular in perioperative medicine and anesthesia, as NMDA inhibitors, local anesthetics
intravenous, agonists alpha2 and beta-blockers. Some authors is likely pointing analgesic
effect of intraoperative infusion of esmolol.
In this context, esmolol emerges as a drug insurance and significant effects, with impact on
the quality of the anesthetic technique and the use of which should be further studied and
expanded.
The patients underwent a prospective, randomized, double blind, and placebo controlled study
in which the examiners responsible for intra and post-operative will not know which group
they were randomly allocated: C group (n = 30) and E group (n = 30).
Both groups will receive general inhaled balanced anesthesia with sevoflurane and
remifentanil.
Rapid infusion of 0. 9% saline 500 ml, in both groups. In the E group is added to this
solution the loading dose of esmolol with 500 mcg/kg and in group C will only be infused
saline 0. 9% . One infusion pump containing the result of randomization: Esmolol 100
mcg/kg/min (E group) and saline (C group).
In the clinical record, the following information will be emphasized: Blood pressure and
heart rate intraoperative, perioperative side effects, quantify pain by Visual Analogue
Scale (VAS) (ranging from 0 to 10 cm, zero being found when the patient is no pain and ten,
with maximum or unbearable pain), Verbal Rating Scale (VRS), consisting of a list of phrases
(no pain, mild pain, moderate pain, intense pain, maximum pain) and qualification of pain
assessed by the amount of analgesics required postoperatively and the time to request them.
The results were analyzed statistically with the Statistical Package for Social Sciences
(SPSS) version 22 (SPSS Inc., Chicago, IL, EUA) using parametric and nonparametric tests,
depending on the nature of the variables studied. Data were tested for normality using the
Shapiro-Wilk test. Measures of central tendency (means) and dispersion (standard deviation)
were used. The level of significance was set at < 0. 05. The following tests were used:
Mann-Whitney test for age, duration of anesthesia and surgery, time to first analgesic
supplementation, total amount of analgesics, pain intensity; Student t-test for weight and
height.
Eligibility
Minimum age: 18 Years.
Maximum age: 75 Years.
Gender(s): Female.
Criteria:
Inclusion Criteria:
- Female patients, aged 18 to 75 years, electively scheduled to perform mastectomy in
the Base Hospital of the Federal District;
- Physical State 1 or 2 the American Society of Anesthesiology (ASA);
Exclusion Criteria:
- Patients under the age of 18 years and above 75 years;
- Patients with unstable angina
- Patient with poorly controlled asthma
- Substance abuse
- Sinus bradycardia
- Heart failure, greater than first degree atrioventricular block
- Pregnant women
- Patients with allergy to dipyrone, morphine;
- Patients with chronic pain;
- Patients with severe hepatic disease;
- Patients with severe kidney disease;
- Patients with neurological diseases;
- Included patients in other clinical studies currently or in the past three months
under general anesthesia;
- Patients who refuse to participate in the study;
- Any other condition that, in the opinion of the investigator, may pose a risk to the
patient or interfere with the study objectives;
Locations and Contacts
Fabricio T Mendonca, MD, TSA, Phone: +556181882640, Email: fabricio.tavares@me.com
Hospital de Base do Distrito Federal, Brasilia, DF 70680250, Brazil; Recruiting Jamil Elias, MD, Phone: 556133151588, Email: uamphbdf@gmail.com Viviane Rezende, MD, Phone: 556133151331, Email: vrezende@icab.med.br
Additional Information
Related publications: Celebi N, Cizmeci EA, Canbay O. [Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial]. Rev Bras Anestesiol. 2014 Sep-Oct;64(5):343-9. doi: 10.1016/j.bjan.2013.10.013. Epub 2014 Jun 21. Portuguese. Kim Y, Hwang W, Cho ML, Her YM, Ahn S, Lee J. The effects of intraoperative esmolol administration on perioperative inflammatory responses in patients undergoing laparoscopic gastrectomy: a dose-response study. Surg Innov. 2015 Apr;22(2):177-82. doi: 10.1177/1553350614532534. Epub 2014 May 6.
Starting date: June 2015
Last updated: June 24, 2015
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