Effect of Postoperative Single Dose of Ketamine on Pain After Mastectomy

• ClinicalTrials.gov Identifier: NCT04831736
• Recruitment Status: Recruiting
• First Posted: April 5, 2021
• Last Update Posted: March 4, 2022
• Sponsor: NYU Langone Health
• Information provided by (Responsible Party): NYU Langone Health

Study Description

Brief Summary:

This is a randomized, single blinded, placebo-controlled trial to study the effectiveness of a subanesthetic dose (0.6mg/kg) of ketamine versus placebo (saline) on postoperative pain on adult women undergoing mastectomy.

The objective of the study is to examine the effect of a subanesthetic dose (0.6mg/kg) of ketamine vs. saline control on postoperative pain in subjects who have undergone mastectomy.

Condition or disease	Intervention/treatment	Phase
Postoperative Pain	Drug: Ketamine; Drug: Placebo	Phase 4

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 30 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Participant)
• Primary Purpose: Treatment
• Official Title: Randomized, Single-blind, Placebo-controlled Study on the Effect of Postoperative Administration of Single Dose Ketamine After Mastectomy on Pain
• Actual Study Start Date: April 26, 2021
• Estimated Primary Completion Date: March 31, 2022
• Estimated Study Completion Date: March 31, 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Treatment	Drug: Ketamine; Ketamine at a dose of 0.6 mg/kg will be administered intravenously (IV) while the participant is recovering in the PACU. The study drug will be administered over at least 30 minutes at one time point and will be administered after subject has been deemed to be stable (hemodynamically stable, awake) by the study team on POD 0.
Placebo Comparator: Control	Drug: Placebo; Matching equal dose of saline placebo will be administered intravenously while the participant is recovering in the PACU.

Outcome Measures

Primary Outcome Measures :

1. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: 24 hours post-op ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.
2. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: 48 hours post-op ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.

Secondary Outcome Measures :

1. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: Baseline, Day 0 ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.
2. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: Day 1 post-op ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.
3. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: Day 2 post-op ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.
4. Brief Pain Inventory-short form (BPI) Pain Severity Subscale Score [ Time Frame: Day 7 post-op ]
   BPI Pain Severity Subscale consists of 4 questions (asking to rate pain). Each question is answered on a scale 0 (no pain) to 10 (pain as bad as you can imagine). The total range of score is 0-40; the higher the score, the worse the pain.
5. Brief Pain Inventory-short form (BPI) Pain Interference Subscale Score [ Time Frame: Baseline, Day 0 ]
   BPI Pain Interference Subscale consists of 7 questions (asking to describe how pain has interfered during activities). Each question is answered on a scale 0 (does not interfere) to 10 (completely interferes). The total range of score is 0-70; the higher the score, the worse the interference.
6. Brief Pain Inventory-short form (BPI) Pain Interference Subscale Score [ Time Frame: Day 1 post-op ]
   BPI Pain Interference Subscale consists of 7 questions (asking to describe how pain has interfered during activities). Each question is answered on a scale 0 (does not interfere) to 10 (completely interferes). The total range of score is 0-70; the higher the score, the worse the interference.
7. Brief Pain Inventory-short form (BPI) Pain Interference Subscale Score [ Time Frame: Day 2 post-op ]
   BPI Pain Interference Subscale consists of 7 questions (asking to describe how pain has interfered during activities). Each question is answered on a scale 0 (does not interfere) to 10 (completely interferes). The total range of score is 0-70; the higher the score, the worse the interference.
8. Brief Pain Inventory-short form (BPI) Pain Interference Subscale Score [ Time Frame: Day 7 post-op ]
   BPI Pain Interference Subscale consists of 7 questions (asking to describe how pain has interfered during activities). Each question is answered on a scale 0 (does not interfere) to 10 (completely interferes). The total range of score is 0-70; the higher the score, the worse the interference.
9. Total dosage of opioid use [ Time Frame: Baseline, Day 0 ]
   Use and dosage will be assess through medical records and subject reports.
10. Total dosage of opioid use [ Time Frame: Day 1 post-op ]
    Use and dosage will be assess through medical records and subject reports.
11. Total dosage of opioid use [ Time Frame: Day 2 post-op ]
    Use and dosage will be assess through medical records and subject reports.
12. Total dosage of opioid use [ Time Frame: Day 7 post-op ]
    Use and dosage will be assess through medical records and subject reports.
13. Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 7b Daily Score [ Time Frame: Baseline, Day 0 ]
    The PROMIS Fatigue Short Form consists of 7 questions. Each is answered with a score from 1 (never) to 5 (always). The total range of score is 1-35; the higher the score, the higher the frequency of fatigue.
14. Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 7b Daily Score [ Time Frame: Day 1 post-op ]
    The PROMIS Fatigue Short Form consists of 7 questions. Each is answered with a score from 1 (never) to 5 (always). The total range of score is 1-35; the higher the score, the higher the frequency of fatigue.
15. Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 7b Daily Score [ Time Frame: Day 2 post-op ]
    The PROMIS Fatigue Short Form consists of 7 questions. Each is answered with a score from 1 (never) to 5 (always). The total range of score is 1-35; the higher the score, the higher the frequency of fatigue.
16. Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 7b Daily Score [ Time Frame: Day 7 post-op ]
    The PROMIS Fatigue Short Form consists of 7 questions. Each is answered with a score from 1 (never) to 5 (always). The total range of score is 1-35; the higher the score, the higher the frequency of fatigue.
17. Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (Short Form 6A) Score [ Time Frame: Baseline, Day 0 ]
    The PROMIS Sleep Disturbance Short Form consists of 6 statements. Each is answered with a score of 1-5 (varies). The total range of score is 1-30; the lower the score, the better the quality of sleep.
18. Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (Short Form 6A) Score [ Time Frame: Day 7 post-op ]
    The PROMIS Sleep Disturbance Short Form consists of 6 statements. Each is answered with a score of 1-5 (varies). The total range of score is 1-30; the lower the score, the better the quality of sleep.
19. Generalized Anxiety Disorder (GAD-2) Score [ Time Frame: Baseline, Day 0 ]
    GAD-2 consists of 2 statements/problems (assessing how often one has been bothered by the problems). Each is answered with a score of 0 (not at all) to 3 (nearly every day). The total range of score is 0-6; the higher the score, the more frequent one is bothered by anxiety.
20. Generalized Anxiety Disorder (GAD-2) Score [ Time Frame: Day 7 post-op ]
    GAD-2 consists of 2 statements/problems (assessing how often one has been bothered by the problems). Each is answered with a score of 0 (not at all) to 3 (nearly every day). The total range of score is 0-6; the higher the score, the more frequent one is bothered by anxiety.
21. Breast Cancer Pain Questionnaire (BCPQ) - Pain Score [ Time Frame: Day 7 post-op ]
    If the patient reports pain in the area of the breast, armpit, side of the body, or arm on the side of operation, dependent on the location, the patient will be asked to report level of pain (0 is no pain and 10 is the worst pain imaginable). For each location, the total score is 0-10; the higher the score, the worse the pain.
22. Quality of Recovery (QoR-15) Survey Score [ Time Frame: Day 2 post-op ]

    Part A of QoR-15 consists of 10 conditions. Based on how the patient has been feeling in the last 24 hours, they will respond to each condition (0 to 10, where 0 is none of the time [poor] and 10 is all of the time [excellent]). The total range of score for Part A is 0-100; the higher the score, the better the participant has been feeling.

    Part B consists of 5 symptoms. The patient will respond to each symptom on whether they have experienced any in the last 24 hours (10 to 0, where 10 is none of the time [excellent] and 10 is all of the time [none]). The total range of score for Part B is 0-50; the higher the score, the worse.

23. Quality of Recovery (QoR-15) Survey Score [ Time Frame: Day 7 post-op ]

    Part A of QoR-15 consists of 10 conditions. Based on how the patient has been feeling in the last 24 hours, they will respond to each condition (0 to 10, where 0 is none of the time [poor] and 10 is all of the time [excellent]). The total range of score for Part A is 0-100; the higher the score, the better the participant has been feeling.

    Part B consists of 5 symptoms. The patient will respond to each symptom on whether they have experienced any in the last 24 hours (10 to 0, where 10 is none of the time [excellent] and 10 is all of the time [none]). The total range of score for Part B is 0-50; the higher the score, the worse.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 80 Years (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Gender Based Eligibility: Yes
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Adult women, aged 18 to 80 years old, who will undergo mastectomy.
2. Willing to comply with all study procedures and be available for the duration of the study.
3. Will be scheduled for elective breast surgery for oncologic indication as follows: mastectomy +/- lymph node dissection, prophylactic mastectomy, unilateral or bilateral, with immediate reconstruction
4. No distant metastases.
5. Subject is American Society of Anesthesiologists (ASA) physical status 1, 2, or 3.
6. Subject is medically stable.

Exclusion Criteria:

1. Cognitive impairment (by history) or clinical signs of altered mental status such as confusion, amnesia, disorientation, fluctuating levels of alertness, etc. that may interference with adherence to study procedures and/or participant safety.
2. Past ketamine or phencyclidine misuse or abuse.
3. Schizophrenia or history of psychosis.
4. Known sensitivity or allergy to ketamine.
5. Liver or renal insufficiency.
6. History of uncontrolled hypertension, chest pain, cardiac arrythmia, stroke, head trauma, intracranial mass or hemorrhage or pressure, glaucoma, acute globe injury, uncontrolled thyroid disease, porphyria, or any other contraindication to ketamine. Use of lamotrigine, alfentanil, physostigmine, and 4-aminopyridine are contraindicated
7. Pregnancy or nursing women
8. BMI>35.
9. Currently participating in another pain interventional trial.
10. Unwillingness to give informed consent.
11. Non-English speaking patients as QoR-15 and BCPQ have not been validated in all other languages

Contacts and Locations

Contacts

Contact: Lisa Doan, MD; 212-201-1004; Lisa.Doan@nyulangone.org

Contact: Anna Li; 212-263-1538; anna.li@nyulangone.org

Locations

United States, New York

NYU Langone Health; Recruiting

New York, New York, United States, 10016

Contact: Anna Li 212-263-1538 anna.li@nyulangone.org

Principal Investigator: Lisa Doan, MD

Sponsors and Collaborators

NYU Langone Health

Investigators

• Principal Investigator: Lisa Doan, MD; NYU Langone Health

More Information

• Responsible Party: NYU Langone Health
• ClinicalTrials.gov Identifier: NCT04831736
• Other Study ID Numbers: 21-00072
• First Posted: April 5, 2021
• Last Update Posted: March 4, 2022
• Last Verified: March 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices) will be shared upon reasonable request.
• Supporting Materials: Study Protocol
• Time Frame: Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.
• Access Criteria: The investigator who proposed to use the data will have access to the data upon reasonable request. Requests should be directed to lisa.doan@nyulangone.org. To gain access, data requestors will need to sign a data access agreement.

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: Yes

Keywords provided by NYU Langone Health:

Mastectomy

Additional relevant MeSH terms:

Pain, Postoperative; Postoperative Complications; Pathologic Processes; Pain; Neurologic Manifestations; Ketamine; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Anesthetics, Dissociative; Anesthetics, Intravenous; Anesthetics, General; Anesthetics; Central Nervous System Depressants; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action