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History of Changes for Study: NCT04933149
Ketamine Infusion for Neuropathic Pain in Brachial Plexus Injuries
Latest version (submitted December 29, 2021) on ClinicalTrials.gov
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Study Record Versions
Version A B Submitted Date Changes
1 June 15, 2021 None (earliest Version on record)
2 July 13, 2021 Study Status
3 November 5, 2021 Recruitment Status, Study Status and Contacts/Locations
4 December 29, 2021 Recruitment Status, Study Status, Contacts/Locations and Arms and Interventions
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Study NCT04933149
Submitted Date:  June 15, 2021 (v1)

Open or close this module Study Identification
Unique Protocol ID: 20-011213
Brief Title: Ketamine Infusion for Neuropathic Pain in Brachial Plexus Injuries
Official Title: Ketamine Infusion for Treatment of Chronic Neuropathic Pain in Traumatic Brachial Plexus Injuries, a Prospective Randomized Control Study
Secondary IDs:
Open or close this module Study Status
Record Verification: June 2021
Overall Status: Not yet recruiting
Study Start: July 1, 2021
Primary Completion: May 1, 2023 [Anticipated]
Study Completion: June 1, 2023 [Anticipated]
First Submitted: June 15, 2021
First Submitted that
Met QC Criteria:
June 15, 2021
First Posted: June 21, 2021 [Actual]
Last Update Submitted that
Met QC Criteria:
June 15, 2021
Last Update Posted: June 21, 2021 [Actual]
Open or close this module Sponsor/Collaborators
Sponsor: Mayo Clinic
Responsible Party: Principal Investigator
Investigator: Alexander Y. Shin, M.D.
Official Title: Principal Investigator
Affiliation: Mayo Clinic
Collaborators:
Open or close this module Oversight
U.S. FDA-regulated Drug: Yes
U.S. FDA-regulated Device: No
Data Monitoring: No
Open or close this module Study Description
Brief Summary: The purpose of this study is to assess pre- and postoperative neuropathic pain in patients with traumatic brachial plexus injuries to determine if intraoperative ketamine infusion affect neuropathic pain associated with avulsion injuries of the brachial plexus.
Detailed Description:

Neuropathic pain following traumatic brachial plexus injuries is a common and debilitating problem that has been reported in up to 64-75% of patients. Neuropathic pain is difficult to treat, particularly when secondary to avulsion injuries of the brachial plexus. Current treatment options include neuromodulating pharmacologic agents including gabapentin, pregabalin, tricyclic antidepressants, and duloxetine among others. Other analgesic modalities include TENS unit application, massage, acupuncture, and topical medications. Despite these treatment options, patients frequently continue to experience significant, debilitating neuropathic pain.

The use of ketamine has recently been studied in complex regional pain syndrome (CRPS), spinal cord injuries, and chronic neuropathic pain with encouraging results. Ketamine is thought to exert its analgesic properties via noncompetitive central nervous system N-methyl-D-aspartate (NMDA) antagonism among other primarily central mechanisms including sodium channel blockade, activation of D2 dopamine receptors and facilitation of γ-aminobutyric acid A (GABA-A) signaling. It is utilized clinically in acute and chronic pain management primarily in hospitalized settings to treat a variety of pain states as well as medically refractory depression and headache disorders. The dosing and administration of ketamine infusion varies widely across studies and includes oral ketamine, low dose infusions, and infusions producing an anesthetic effect. To our knowledge, ketamine's use in subanesthetic doses has not been adequately evaluated in patients with neuropathic pain following traumatic brachial plexus injuries. Our study aims to determine how intraoperative ketamine infusion alters neuropathic pain severity associated with brachial plexus avulsion injury in the post-operative period. In addition, we hypothesize that patients receiving intraoperative ketamine infusion will require less narcotic pain medication through the follow-up period of 6 months following surgery.

Patients who are undergoing planned surgery for brachial plexus reconstruction at Mayo Clinic will be enrolled into this study to be randomized into getting ketamine infusions or a placebo medication during surgery and in the 24 hour postoperative period after surgery. Pain will be measured before surgery and at various time points to up to 6 months after surgery through online pain measurement scores.

Open or close this module Conditions
Conditions: Brachial Plexus Injury
Keywords:
Open or close this module Study Design
Study Type: Interventional
Primary Purpose: Treatment
Study Phase: Phase 4
Interventional Study Model: Parallel Assignment
Number of Arms: 2
Masking: Double (Participant, Care Provider)
Allocation: Randomized
Enrollment: 100 [Anticipated]
Open or close this module Arms and Interventions
Arms Assigned Interventions
Experimental: Ketamine Infusion Group
Subjects will receive ketamine infusion during their planned surgery and postoperatively.
Drug: Ketamine Infustion
Intravenous infusion at 0.5 mg/kg/hr from induction to emergence from anesthesia during the subject's brachial plexus reconstruction surgery. In addition, subjects will receive postoperative ketamine infusion of 0.1-0.3 mg/kg/hr for 24 hours titrated to side effects while patients are admitted to the hospital following surgery.
No Intervention: Standard of Care Group
Subjects will receive general anesthesia as standard of care during their planned surgery
Open or close this module Outcome Measures
Primary Outcome Measures:
1. Change in PROMIS Pain Quality - Neuropathic Pain (PQ-Neuro) score
[ Time Frame: Baseline, 1 week ]

Measured by the PROMIS Pain Quality - Neuropathic Pain (PQ-Neuro) self-reported questionnaire asking about pain in the past 7 days using a scale of 1=not at all and 5=very much. Higher scores indicate a worse outcome.
Secondary Outcome Measures:
1. Opioid medication use
[ Time Frame: Baseline, 1 week postoperatively ]

Change in opioid medication use measured by oral morphine equivalents (OMEs) at postoperative week 1 from baseline
2. Pain Score
[ Time Frame: 1 day postoperatively ]

Measured using the Visual Analogue Scale for pain rated from 0-10, where 0 is no pain and 10 is the worst pain imaginable.
3. Adverse Events
[ Time Frame: 6 weeks ]

Number of participants to experience sepsis, embolism, wound healing failure, hematomas, or nightmares/hallucinations following surgery
Open or close this module Eligibility
Minimum Age: 18 Years
Maximum Age:
Sex: All
Gender Based:
Accepts Healthy Volunteers: No
Criteria:

Inclusion Criteria:

  • Patients with neuropathic pain associated with avulsion injuries following traumatic brachial plexus injuries scheduled for brachial plexus exploration and reconstruction by three senior surgeons at Mayo Clinic (AYS, ATB, RJS):
  • Neuropathic pain defined as pain directly related to injury to the somatosensory system, and score >4/10 on the Douleur Neuropathique en 4 Questions (DN4) neuropathic pain questionnaire. Symptoms of neuropathic pain include allodynia, hyperalgesia, burning, needle-like, throbbing, shooting, or electrical-type sensation.
  • Nerve root avulsion on CT myelogram.
  • Traumatic brachial plexus injuries defined as blunt or penetrating trauma resulting in injury and dysfunction along the course of the brachial plexus defined as nerve roots C5-T1, trunks, divisions, cords, and terminal branches.

Exclusion Criteria:

  • Patients without pain following traumatic brachial plexus injuries.
  • Patients with brachial plexus injuries due to non-traumatic causes such as tumors, infection, radiation, or inflammatory disorders such as Parsonage Turner Syndrome.
  • Patients who do not require surgery for exploration/reconstruction at the brachial plexus.
  • Patients under 18 years of age.
  • Contraindication to ketamine use (severe hepatic dysfunction -cirrhosis, high-risk coronary artery disease, poorly controlled psychiatric condition- schizophrenia.
Open or close this module Contacts/Locations
Study Officials: Alexander Shin, MD
Principal Investigator
Mayo Clinic
Locations: United States, Minnesota
Mayo Clinic in Rochester
Rochester, Minnesota, United States, 55905
Open or close this module IPDSharing
Plan to Share IPD:
Open or close this module References
Citations:
Links: Description: Mayo Clinic Clinical Trials
Available IPD/Information:

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