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Trial registered on ANZCTR
Registration number
ACTRN12624000834550p
Ethics application status
Submitted, not yet approved
Date submitted
20/06/2024
Date registered
5/07/2024
Date last updated
5/07/2024
Date data sharing statement initially provided
5/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Effectiveness of a custom anaesthetic solution on postoperative pain in hand surgery: a pilot study.
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Scientific title
Effectiveness of a custom anaesthetic solution (combination of clonidine, adrenaline, ropivacaine, lidocaine, dexamethasone) on postoperative pain in hand surgery: a pilot study
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Secondary ID [1]
312379
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Nil known
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Universal Trial Number (UTN)
U1111-1309-5324
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
postoperative pain management
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dupuytren's disease
334171
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carpal tunnel syndrome
334172
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hand surgery
334241
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Condition category
Condition code
Anaesthesiology
330838
330838
0
0
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Pain management
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Surgery
330839
330839
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0
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Other surgery
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients will be randomly assigned to either the custom solution (CLARD) group or conventional local anaesthetic (LR) group with a 1:1 ratio. The random selection will be performed on the day of surgery by the relevant investigator, who will choose an unmarked envelope from a predetermined number of envelopes containing the assignments in a 1:1 ratio. The relevant investigator will be blinded to the selection.
The conventional local anaesthetic group will receive a combination of 10ml plain 1% ropivacaine, 2ml 10% lidgnocaine, and 8ml normal saline (0.9% per 100ml), for a total of 20ml solution, via subcutaneous local infiltration with a 20ml syringe and 21 gauge needle. The CLARD group will receive a combination of 10ml 1% ropivacaine, 2ml compromised of 10% lidgnocaine + 8mg dexamethasone + 75mcg clonidine, 2ml 1:10,000 adrenaline, and 3.5ml normal saline, for a total of 17.5ml custom solution, via subcutaneous local infiltration with a 20ml syringe and 21 gauge needle. In order for the Anaesthesiologist to be blinded, they will draw up both solutions for each case. Their anaesthetic nurse (who will not be an investigator), will then hand the Anaesthetist the randomly drawn assignment to be infiltrated. A standardised anaesthetic technique and local anaesthetic administration method – subcutaneous local infiltration around the median, radial and ulnar nerves at the level of the proximal wrist crease - will be used for all cases. The local anaesthetic will be administered to participants 5 minutes prior to the start of surgery. All other aspects of the surgical procedure including prophylactic antibiotics, surgical technique and closure will be performed in a standardized manner by a single Plastic and Reconstructive Surgeon.
Postoperatively, patients will all receive the same pain management protocol on discharge, 2 tablets of Panadol Osteo three times a day regularly for 5 days then as required, and 10 tablets of Tapentadol Immediate Release 50-100mg for use 4 times a day as required. No anti-inflammatories will be provided on discharge and patients will be instructed not to take any in the post-operative study period.
At their first follow up appointment 1 week postoperatively, patients will be asked to complete a VAS detailing postoperative pain, and a questionnaire outlining time to first opiate usage and total opiate usage. Patients will also be followed up in hand therapy clinic for functional testing as well as hand therapy.
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Intervention code [1]
328877
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Treatment: Drugs
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Comparator / control treatment
The conventional local anaesthetic group (control) will receive a combination of 10ml plain 1% ropivacaine, 2ml 10% lidgnocaine, and 8ml normal saline (0.9% per 100ml), for a total of 20ml solution, via subcutaneous local infiltration with a 20ml syringe and 21 gauge needle.
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Control group
Active
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Outcomes
Primary outcome [1]
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Total opioid analgesic consumption
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Assessment method [1]
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Total dosage of Tapentadol. This will be measured at defined follow up time points, patients will be asked to complete a VAS detailing postoperative pain, and a questionnaire outlining time to first opiate usage and total opiate usage. Tapentadol is the only analgesic assessed for this outcome, patients will be instructed not to take any other opiod analgesics or anti-inflammatories in the post-operative study period.
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Timepoint [1]
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6 weeks postoperatively
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Secondary outcome [1]
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Time to first usage of opioid analgesia postoperatively
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Assessment method [1]
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Time to first usage of opioid analgesia (hours, days) via patient questionnaire. The questionnaire is specifically designed for this study.
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Timepoint [1]
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baseline, 2, 4, 6 and 8 weeks postoperatively
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Secondary outcome [2]
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Subjective postoperative pain
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Assessment method [2]
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Visual analogue score and patient questionnaire. The questionnaire is specifically designed for this study.
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Timepoint [2]
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Baseline, 2, 4, 6 and 8 weeks postoperatively
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Secondary outcome [3]
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Hand function
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Assessment method [3]
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Outcome measures used to measure postoperative hand function will include the QuickDASH, Active Range of Movement (AROM) via finger goniometry, and Grip Strength in Kilograms using a hand-held grip dynamometer. This is a composite secondary outcome.
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Timepoint [3]
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All participants will have the above measures and their changes assessed pre-operatively, and two, four, and eight weeks post operatively.
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Eligibility
Key inclusion criteria
The study will include patients >18 years of age who will receive either open carpal tunnel release, open fasciectomy for Dupuytrens disease or both procedures in the same operation at Holmesglen Private Hospital.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Patients who are <18 years of age, have evidence of cognitive impairment as formally diagnosed by a specialist physician or neuropsychologist, or have a history of chronic pain or chronic opioid use, or are actively taking a list of prohibited anti-inflammatory medications prior to the intervention will be excluded from the study. The list of prohibited anti-inflammatory medications includes ibuprofen, naproxen, diclofenac, and celecoxib. Patients who develop any Clavien grade complication postoperatively were will also be excluded.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using procedures like coin-tossing
and dice-rolling
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/08/2024
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
60
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Holmesglen Private Hospital - Moorabbin
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Recruitment postcode(s) [1]
42759
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3189 - Moorabbin
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Self funded/Unfunded
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Address [1]
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Country [1]
316785
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Primary sponsor type
Individual
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Name
Yi Xie - Peninsula Health
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Address
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Country
Australia
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Secondary sponsor category [1]
319007
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None
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Name [1]
319007
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Address [1]
319007
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Country [1]
319007
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
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Monash Health Human Research Ethics Committee A
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Ethics committee address [1]
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https://monashhealth.org/research/resources/resource-library/
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/05/2024
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Approval date [1]
315556
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Ethics approval number [1]
315556
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Summary
Brief summary
This will be a pilot study to determine efficacy of combination clonidine, adrenaline, ropivacaine, lidocaine, dexamethasone combination in reducing pain, time to first opioid analgesia, and total opioid analgesia consumption postoperatively compared with combination lidocaine and ropivacaine. We hypothesise that the combination of the above medication will contribute to a longer lasting postoperative anaesthetic effect, such that patients will be more comfortable in the 24-48 hours post surgery, requiring less usage of opiate analgesia, and a quicker return to premorbid activity and function.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Yi Xie
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Address
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Frankston Hospital, 2 Hastings Road, Frankston VIC 3199
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Country
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Australia
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Phone
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+61416068801
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Yi Xie
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Address
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Frankston Hospital, 2 Hastings Road, Frankston VIC 3199
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Country
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Australia
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Phone
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+61416068801
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Yi Xie
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Address
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Frankston Hospital, 2 Hastings Road, Frankston VIC 3199
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Country
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Australia
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Phone
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+61416068801
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Fax
135068
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Individual participant data underlying published results only
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When will data be available (start and end dates)?
Immediately following publication, no end date
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Available to whom?
Anyone who wishes to access it
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Available for what types of analyses?
Any purpose
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How or where can data be obtained?
Access subject to approvals by Principal Investigator (
[email protected]
)
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
23909
Informed consent form
[email protected]
23910
Study protocol
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF