Effects of Dexmedetomidine During Radiofrequency Ablation of Abdominal Tumours

Phase 4CompletedNCT02016391

Uppsala University Hospital50 enrolled

Overview

The purpose of he study is to evaluate effects of dexmedetomidine on pain during radiofrequency ablation of liver and kidney tumours.

Although radiofrequency ablation (RF) is accepted as the best therapeutic choice for patients with early stage hepatocellular carcinoma when liver transplantation or surgical resection are not suitable options, it is still performed only in a few hospitals and experience is so far limited (Goldberg \& Ahmed, 2002; Shiina et al., 2005). In addition, RF ablation is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Although radiofrequency ablation has been accepted as a safe and effective treatment for liver and kidney tumours, there are few studies addressing periprocedural pain. Thus, the optimal anaesthetic procedure is still to be determined. Currently at our institution RF is performed as monitored sedation procedure using remifentanil infusion supplemented with midazolam boluses, when considered necessary. However, when using remifentanil and midazolam combination it is quite difficult to avoid too deep respiratory depression. Dexmedetomidine is an α2-adrenoreceptor agonist with sedative, analgesic and anxiolytic effects, and it has more selective α2-adrenergic effect than clonidine. Dexmedetomidine has a great deal of potential in this arena given its analgesic and anxiolytic properties while preserving respiratory drive (Bergese SD et al., 2010). All patients will receive dexmedetomidine 0.4 µg/kg/hr infusion from the start of procedure. The infusion will be continued during the whole RF procedure. At the same time all patients will receive remifentanil infusion according to TCI (target controlled infusion) protocol. Plasma concentration target will be set from 0.5 ng/ml and, if necessary, will be increased to achieve a comfortable state of patient (Ramsey Sedation Scale: 2-3).

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Cancer of Kidney and Renal Pelvis Cancer of Liver

Interventions

DexmedetomidineDRUG

Dexmedetomidine 0.4 µg/kg/hr infusion during RF procedure

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * liver or/and kidney cancer for which radiofrequency ablation procedure is planned * signed informed consent form Exclusion Criteria: * patient refusal * pregnancy * known allergy to dexmedetomidine or remifentanil * atrioventricular block grade II or III or other significant cardiac conduction disturbance * stroke * low blood pressure not responding to treatment

Locations (1)

Uppsala University Hospital

Uppsala, Sweden

Outcomes

Primary Outcomes

Patient Satisfaction With Sedation Technique

Rating of how satisfied the patient was with their sedation on a scale of 1-5 with 1 being very dissatisfied and 5 being extremely satisfied

Time frame: After completion of procedure (within 15 minutes)

Secondary Outcomes

Vital signs: blood pressure, oxygen saturation, heart rate, breathing rate

Time frame: During procedure and up to 2 hours stay at the post-anesthesia care unit

Ramsey Sedation Scale Score

Rating of depth of sedation. Scale 1 - 6, 1 being wide awake and 6 being non-responsive

Time frame: During the procedure and up to 2 hours stay at the post-anesthesia care unit

Maximal pain intensity

The 11-point Numerical Rating Scale (NRS) to assess periprocedural pain. Scale of 0-10, with 0:no pain and 10: pain as bad as it could be

Time frame: During procedure and up to 2 hours stay at the post-anesthesia care unit

Data from ClinicalTrials.gov

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