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- Title
N-Methyl-D-Aspartate Antagonists and Steroids for the Prevention of Persisting Post-Surgical Pain After Thoracoscopic Surgeries: A Randomized Controlled, Factorial Design, International, Multicenter Pilot Trial.
- Authors
Shanthanna, Harsha; Turan, Alparslan; Vincent, Jessica; Saab, Remie; Shargall, Yaron; O'Hare, Turlough; Davis, Kimberly; Fonguh, Sylvanus; Balasubramaniam, Kumar; Paul, James; Gilron, Ian; Kehlet, Henrik; Sessler, Daniel I; Bhandari, Mohit; Thabane, Lehana; Devereaux, PJ
- Abstract
Purpose: We conducted a feasibility 2× 2 factorial trial comparing N-methyl-D-aspartate (NMDA) antagonists (intravenous ketamine and oral memantine) versus placebo and intravenous steroids versus placebo, in patients having elective video-assisted thoracic surgery lobectomies, at St. Joseph's Hamilton, Canada, and Cleveland Clinic, Cleveland, USA. Our feasibility objectives were: 1) recruitment rate/week; 2) recruitment of ≥ 90% of eligible patients; and 3) > 90% follow-up. Secondary objectives were incidence and intensity of persistent post-surgical pain (PPSP) and other clinical and safety outcomes. Methods: Using computerized randomization, patients were allocated to one of four groups: NMDA active with steroid placebo; NMDA placebo with steroid active; both NMDA and steroid active; both NMDA and steroid placebo. Patients, health providers, and data analysts were blinded to allocation. Patients were followed for 3 months after randomization. Results: The trial was initiated in May 2017 at Hamilton and, after subsequent regulatory and ethics approval, in April 2018 at Cleveland. The trial had to be stopped after only 1 month of recruitment in Cleveland because the packaged study medications (memantine) expired and we were unable to procure the dosage required. Among 41 eligible patients, 27 (66%) were randomized. The recruitment rate/week was 0.63, 95% confidence interval (CI): 0.47– 0.79 in Hamilton; and 1, 95% CI: 0.83– 1.17 in Cleveland. Follow-up was complete for all 24 patients (100%) in Hamilton, and 3 of 4 patients in Cleveland. In total, only 4 patients (15%), and 2 patients (7%) had persistent pain at rest and with movement, respectively. There were no significant differences between groups for other outcomes. Conclusion: The trial had to be stopped prematurely due to non-availability of study medications. Trial feasibility objectives of recruiting 90% of eligible patients and recruiting at least one patient/week per site were not met. Consideration for protocol changes will be necessary for the full trial. Trial Registration: NCT02950233.
- Subjects
CLEVELAND (Ohio); FACTORIAL experiment designs; CHEST endoscopic surgery; VIDEO-assisted thoracic surgery; METHYL aspartate; LOBECTOMY (Lung surgery); CHRONIC pain; STEROIDS
- Publication
Journal of Pain Research, 2020, Vol 13, p377
- ISSN
1178-7090
- Publication type
Article
- DOI
10.2147/JPR.S237058