Ignite Creation Date:
2024-10-26 @ 3:35 PM
Last Modification Date:
2024-10-26 @ 3:35 PM
Study NCT ID:
NCT06520150
Status:
RECRUITING
Last Update Posted:
None
First Post:
2024-07-08
Brief Title:
Evaluation of the Effectiveness of Two Methods of Regional Anesthesia During S-ICD Implantation Procedure
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Evaluation of the Effectiveness of Two Methods of Regional Anesthesia During Subcutaneous Implantable Cardioverter-defibrillator SICD Implantation Procedure
Status:
RECRUITING
Status Verified Date:
2024-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Our study consists of a combination of regional blockade local anesthesia of the anterior and lateral chest wall in the form of a thin needle prick and the supply of local anesthetic drugs to the area of the relevant chest wall structures to exclude all stimuli including pain from the operative site A short-acting analgesic and sedative drug will be administered intravenously throughout the procedure - in a dose that allows the required contact between the patient and the anesthetist If necessary the dose of the drug may be increased to maintain pain comfort throughout the procedure
The anesthetic team will be with the patient throughout the procedure to ensure comfort and safety
The anesthetic team will be with the patient throughout the procedure to ensure comfort and safety
Detailed Description:
The current study is a continuation of the 2021-2023 project during which 16 patients were anesthetized using a combination of previously known regional PSP SSAP blocks in the thoracic area for S-ICD implantation PSP pectoserratus plane block previously known in scientific nomenclature as PECS II DPP PNB II is a block placed under the pectoralis minor muscle between the pectoralis anterior muscle or also under it in the area of the IIIIV rib lateral to the midclavicular line SSAP superficial serratus anterior plane block is formerly known as SABP block which is a block placed at the height of the fifth intercostal in the medialposterior axillary line between the anterior pterygoid muscle and the dorsal widest muscle
In some cases this allowed the procedure to be carried out due to patient burdens relative contraindications and high risk of complications during general anesthesia After studies related to the volume of local anesthetics administered as well as the concentration of their mixture the optimal concentration of the substance used for regional blockade was chosen This is a mixture of 0125 ropivacaine solution with 025 lidocaine solution in a total volume of 60mL of administered solution
Superficial parastenal intercostal plane block SPIP formerly known as TTP PIP PIFP SIP PSP which is an alternative combination in combination with SSAP is a block in which we deposit a local anesthetic in the parasternal line at the level of the 4th and 5th intercostal spaces between the internal intercostal muscle and the transverse thoracic muscle
The purpose of the study is to determine whether SPIPSSAP blockade is the optimal form of anesthesia for S-ICD implantation
The patient after qualifying by the cardiologist for S-ICD implantation will undergo a standard anesthesiological qualification process with evaluation of basic demographic parameters examination of body mass composition by bioimpedance comorbidities medications taken determination of surgical risk according to the ASA scale American Society of Anesthesiology in addition the patient will be checked for any contraindications to the use of regional blockade as a method of anesthesia After qualification the patient will be asked to read the consent to participate in the study and sign the informed consent form
Patients will receive standard premedication in the form of 1g of paracetamol and 150mg of pregabalin orally 30min before the procedure
The subjects will be randomly divided into 2 groups - Group I will be patients administered PSPSSAP anesthesia consecutively 2040ml of the mixture indicated above Group II will be patients given SPIPSSAP blockade consecutively 2040ml of the mixture indicated above It was tentatively planned to conduct the study on a group of 32 patients 16 in each of the two groups
Anesthesiologists administering anesthesia prior to surgery receive an envelope with a randomly indicated method of anesthesia based on simple randomization determines the type of regional blockade used during the procedure The subject will not know which study group he or she has been classified into The operator performing the procedure will not be informed of the type of anesthesia performed -randomization by double-blinding The operator performing the procedure will not be informed about the type of block performed in order to objectivize the extent and quality of the subjects anesthesia which he will evaluate after the procedure according to a scale of subjective operator comfort created EOA scale
During the procedure iv analgesia with the short-acting opioid remifentanil in the dose range of 0025ugkgmin to 01ugkgmin will be administered as needed to control pain
Increasing the dosage of the drug above these doses for pain control will be a disqualifying factor for the patient from further examination and the blockade will be considered ineffective which will be associated with receiving the lowest possible value on the operators comfort scale The use of iv analgesics in the form of ketoprofen 100mg metamizole 25g will also be allowed during the procedure
During the procedure the operator will be allowed to additionally administer local anesthesia to the area of the surgical field where severe pain is experienced Infiltration of the surgical field with a solution of 1 lidocaine with epinephrine in a volume of no more than 40ml will then be performed If it is necessary to exceed the volume of local anesthesia the patient will be disqualified from further examination After the procedure for the purpose of test defibrillation checking the function of the implanted device the patient will be put under short-term deeper sedation with propofol at a single dose of 1-3mgkgmc on one occasion
During the procedure in order to assess the patients pain NRSnumerical pain scale or VASvisual analog scale scales will be checked every 15min At the same intervals the patients level of sedation will be assessed using the RASS Richmond agitationsedation scale and GCS Glasgow level of consciousness scales Parameters such as SpO2 hemoglobin oxygen saturation NIBP non-invasive blood pressure measurement or HR heart rate will be monitored every 5min
The NRS check in post-operative care will be done every 6h on the first day the QoR-15 form post-operative quality of life and improvement scale will be given to the patient to fill in 24h after surgery
In some cases this allowed the procedure to be carried out due to patient burdens relative contraindications and high risk of complications during general anesthesia After studies related to the volume of local anesthetics administered as well as the concentration of their mixture the optimal concentration of the substance used for regional blockade was chosen This is a mixture of 0125 ropivacaine solution with 025 lidocaine solution in a total volume of 60mL of administered solution
Superficial parastenal intercostal plane block SPIP formerly known as TTP PIP PIFP SIP PSP which is an alternative combination in combination with SSAP is a block in which we deposit a local anesthetic in the parasternal line at the level of the 4th and 5th intercostal spaces between the internal intercostal muscle and the transverse thoracic muscle
The purpose of the study is to determine whether SPIPSSAP blockade is the optimal form of anesthesia for S-ICD implantation
The patient after qualifying by the cardiologist for S-ICD implantation will undergo a standard anesthesiological qualification process with evaluation of basic demographic parameters examination of body mass composition by bioimpedance comorbidities medications taken determination of surgical risk according to the ASA scale American Society of Anesthesiology in addition the patient will be checked for any contraindications to the use of regional blockade as a method of anesthesia After qualification the patient will be asked to read the consent to participate in the study and sign the informed consent form
Patients will receive standard premedication in the form of 1g of paracetamol and 150mg of pregabalin orally 30min before the procedure
The subjects will be randomly divided into 2 groups - Group I will be patients administered PSPSSAP anesthesia consecutively 2040ml of the mixture indicated above Group II will be patients given SPIPSSAP blockade consecutively 2040ml of the mixture indicated above It was tentatively planned to conduct the study on a group of 32 patients 16 in each of the two groups
Anesthesiologists administering anesthesia prior to surgery receive an envelope with a randomly indicated method of anesthesia based on simple randomization determines the type of regional blockade used during the procedure The subject will not know which study group he or she has been classified into The operator performing the procedure will not be informed of the type of anesthesia performed -randomization by double-blinding The operator performing the procedure will not be informed about the type of block performed in order to objectivize the extent and quality of the subjects anesthesia which he will evaluate after the procedure according to a scale of subjective operator comfort created EOA scale
During the procedure iv analgesia with the short-acting opioid remifentanil in the dose range of 0025ugkgmin to 01ugkgmin will be administered as needed to control pain
Increasing the dosage of the drug above these doses for pain control will be a disqualifying factor for the patient from further examination and the blockade will be considered ineffective which will be associated with receiving the lowest possible value on the operators comfort scale The use of iv analgesics in the form of ketoprofen 100mg metamizole 25g will also be allowed during the procedure
During the procedure the operator will be allowed to additionally administer local anesthesia to the area of the surgical field where severe pain is experienced Infiltration of the surgical field with a solution of 1 lidocaine with epinephrine in a volume of no more than 40ml will then be performed If it is necessary to exceed the volume of local anesthesia the patient will be disqualified from further examination After the procedure for the purpose of test defibrillation checking the function of the implanted device the patient will be put under short-term deeper sedation with propofol at a single dose of 1-3mgkgmc on one occasion
During the procedure in order to assess the patients pain NRSnumerical pain scale or VASvisual analog scale scales will be checked every 15min At the same intervals the patients level of sedation will be assessed using the RASS Richmond agitationsedation scale and GCS Glasgow level of consciousness scales Parameters such as SpO2 hemoglobin oxygen saturation NIBP non-invasive blood pressure measurement or HR heart rate will be monitored every 5min
The NRS check in post-operative care will be done every 6h on the first day the QoR-15 form post-operative quality of life and improvement scale will be given to the patient to fill in 24h after surgery
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None