The Effect of Combined General-epidural vs General Anaesthesia on Postoperative Gastrointestinal Surgery

• Sponsor: Bnai Zion Medical Center
• Information provided by (Responsible Party): MOSTAFA.SOMRI, Bnai Zion Medical Center

Study Description

Brief Summary:

Sixty neonates and infants will be enrolled and randomised into two groups of n=30 each . For their surgical procedures, one group general (GA) anaesthesia the second group will receive a combined general and epidural anaesthesia (CGEA).

Anaesthetic technique:

Patients in the GA group will be induced with intravenous propofol (2-4 mg.kg-1) and fentanyl (2-4 µg.kg-1) and will receive rocuronium bromide (0.5 mg.kg-1) to facilitate endotracheal intubation. Anaesthesia will be maintained with sevoflurane (2-3%) in an air/oxygen mixture as well as intravenous fentanyl as required.

In the (CGEA) 0.5 ml.kg-1 of 0.25% bupivacaine will be injected into the epidural catheter, followed by a continuous infusion of 0.1% bupivacaine at a rate of 0.2 mg.kg-1.hr-1 for up to 48 hours postoperatively. Assessment of anaesthetic efficacy will be measured Intraoperative care vital signs. And will continuously be monitored with a Datex AS/3 (Engestrom®, Helsinki, Finland) monitor.

The use of antibiotic prophylaxis will be determined by the degree of bowel contamination during surgery, with the commonest regimen consisting of penicillin, gentamicin and metronidazole will be administered. Antibiotics will be continued for 36-48 hours postoperatively to prevent infection arising from the disturbed bowel flora.

Postoperative care, following surgery, will be conducted. The feeding volume will be increased in steps as long as the volume of regurgitated fluid will be less than 20% of the administered breast milk or formula volume. Full feeding will define as oral tolerance of at least 80% of daily maintenance volume. In cases of abdominal distension or vomiting, feeding will withheld until symptom resolution. The nasogastric tube will be removed on bowel function restoration The CRIES score will be use to assess the severity and duration of postoperative pain during the patients' NICU stay. If the CRIES score is ≥4, fentanyl will be continuously intravenously infused in both study group. Fentanyl will be also administered to CGEA patients who experienced pain despite a continuous epidural infusion at 1-5 µg.kg-1.h-1. The amount of fentanyl required for adequate postoperative pain relief will be recorded in both groups.

Condition or disease	Intervention/treatment	Phase
Epidural Anesthesia; Infection; Infant, Newborn, Diseases	Procedure: Combined general and epidural; Procedure: General anaesthesia	Not Applicable

  Show Detailed Description

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 60 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Intervention Model Description: comaring combined general anesthesia and epidural technique to general anaesthsia alone or gastrointestinal recovery and pain managment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: The Effect of Combined General-epidural vs General Anaesthesia on Postoperative Intestinal Function Recovery and Infection in Neonates and Infants Undergoing Gastrointestinal Surgery: a Prospective, Randomised, Controlled Trial
• Estimated Study Start Date: April 2017
• Estimated Primary Completion Date: June 2017
• Estimated Study Completion Date: July 2017

Arms and Interventions

Arm	Intervention/treatment
Experimental: Combined general and epidural; Combined general and epidural anesthesia in infants UNDERGOING INTESTINAL SURGERY	Procedure: Combined general and epidural; Combined general and epidural anaesthesia
Placebo Comparator: General anaesthesia; General anesthesia in infants UNDERGOING INTESTINAL SURGERY	Procedure: General anaesthesia; General anaesthesia

Outcome Measures

Primary Outcome Measures :

1. Postoperative intestinal function recovery for neonates and infants undergoing gastrointestinal surgery. Which anesthetic method be superior and favoured as normal practice general or combined general and epidural anesthesia. [ Time Frame: upto 20 days postoperative ]

   The outcomes measured to determine recovery of intestinal function recovery:

   1. Time to first postoperative defecation measured in hours or days
   2. Duration of nasogastric feeding measured in hours or days
   3. Time to tolerance of full oral feeding measured in hours or days

Secondary Outcome Measures :

1. Rate and sort of postoperative infection [ Time Frame: upto 20 days postoperative ]
   1. Surgical site infection (SSI)
   2. Remote site infection (RSI)

Eligibility Criteria

• Ages Eligible for Study: 1 Month to 6 Months (Child)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Neonates or infants requiring the following major intestinal procedures: duodenoduodenostomy or duodenojejunostomy for duodenal atresia,
• ileocaecal resection for intestinal volvulus,
• ileostomy or colostomy closure for congenital anorectal malformations,
• corrective surgery for Hirschsprung's disease. emergent intestinal surgery.

Exclusion Criteria:

• The exclusion criteria are concurrent coagulopathies,
• sepsis,
• vertebral column malformations,
• neurological disease,
• immunocompromise with or without leukopenia,
• intestinal necrotising enterocolitis.
• Patients will be also excluded if they required exploratory laparotomy or or emergent intestinal surgery

Contacts and Locations

Contacts

Contact: Mostafa Somri, MD; #972-4-8359346; mostafa.somri@b-zion.org.il

Sponsors and Collaborators

Bnai Zion Medical Center

Investigators

• Principal Investigator: Mostafa Somri, M.D.; Bnai Zion Medical Center

More Information

• Responsible Party: MOSTAFA.SOMRI, Prof Mostafa Somri, Bnai Zion Medical Center
• ClinicalTrials.gov Identifier: NCT03056261 History of Changes
• Other Study ID Numbers: BnaiZionMC-16-MS-004
• First Posted: February 17, 2017
• Last Update Posted: February 20, 2017
• Last Verified: February 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by MOSTAFA.SOMRI, Bnai Zion Medical Center:

Combined general-epidural anesthesia intestinal recovery

Additional relevant MeSH terms:

Infection; Infant, Newborn, Diseases; Anesthetics; Central Nervous System Depressants; Physiological Effects of Drugs