Acupuncture for Blood Pressure Fluctuation During Total Laparoscopic Hysterectomy (ASBP)

Ilsan Cha hospital

Status: Enrolling

Conditions: Total Laparoscopic Hysterectomy

Treatments: Device: placebo acupuncture; Device: acupuncture

Study type: Interventional

Funder types: Other

Identifiers

NCT05720884

ICICC-CT-22-05

Details and patient eligibility

About

The goal of this pilot clinical trial is to learn about efficacy of acupuncture about blood pressure fluctuation during total laparoscopic hysterectomy in patients with uterine fibroid.

Participants will receive two times of acupuncture treatment before surgery and researchers will compare to see if acupuncture treatment would stabilize blood pressure fluctuation especially from induction time to post-incision moment.

Full description

After sufficient explanation about the purpose and methods of this clinical study by a researcher, the subject who voluntarily decided to participate and signed a written consent will be evaluated for eligibility at the screening visit. Eligible subjects will be determined as acupuncture group and a placebo control group according to the randomization. Acupuncture treatment is performed twice, one day before surgery and the same day.

On the day of surgery, after entering the operating room, monitoring equipments (non-invasive blood pressure monitor, pulse oxygen saturation, electrocardiogram, anesthesia depth sensor, neuromuscular monitor) will be installed and vital signs including pulse rate, blood pressure, oxygen saturation are measured.

Anesthesia was induced with an anesthetic (intravenous propofol 1-2.5 mg/kg, IV), an analgesic (remifentanyl 0.2mg/hr, IVF), and a muscle relaxant (intravenous rocuronium 0.6-1.2 mg/kg). After induction of anesthesia, anesthesiologist performed tracheal intubation maintaining an appropriate depth of anesthesia (Sedline < 50). Mechanical ventilation started keeping end-tidal CO2 pressure of 25-35 mmHg). Then, an additional venous tube was secured. Additional disinfection process was performed, surgery is prepared.

With the patient in the lithotomy position and under the general anesthesia, the abdomen was prepared, painted and draped with the usual manner. The uterine elevator was inserted. Skin incision was performed and trocar was inserted. The CO2 gas was infused to make pneumoperitoneum which pressure was reached to 12mmHg. Entering into the abdominal cavity, the patient position was changed to the Trendelenburg position. And then the pelvic cavity and whole abdomen were examined. Bilateral pelvic side wall triangles were opened in parallel to infundibulopelvic ligament and ureter dissection was done. The ureteral course was identified, and then the right round ligament and ovarian ligament were coagulated with bipolar endocoagulator, cut with endoscissors. The left sided uterine ligaments were manipulated with the same method as above. The bladder flap was pushed and posterior broad ligament was mobilized. Bilateral uterine vessels were skeletonized and bilateral uterine vessels were coagulated and then cut. Circumferential colpotomy was done with unipolar scissor, and the uterus was removed transvaginally and then vaginal cuff was closed intracorporeal continuous suture. Hemostasis and ureteral peristalsis were assured and abdominal cavity was irrigated with normal saline. The subcutaneous tissue and the skin were closed layer by layer. In all processes, a qualified anesthesiologist whose clinical experience of more than 10 years will control the analgesic or anesthetic injection rate and inhalation gas concentration to maintain the appropriate blood pressure and depth of anesthesia.

Enrollment: 30 estimated patients

Sex: All

Ages: 19 to 69 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Adulthood participants who were planned to have surgical removal of uterus for uterine fibroid and have expected date of total laparoscopic hysterectomy by a gynecologist were eligible.

Inclusion criteria

1. between age of 19 and 69,
2. American Society of Anesthesiologists (ASA) class I or II,
3. required surgical removal of uterus by a gynecology specialist,
4. scheduled to have total laparoscopic hysterectomy in advance.

Exclusion criteria

1. expected survival within 3 months,
2. emergency operation which was not scheduled in advance,
3. hypertension or hypotension that can significantly interfere with the study result,
4. diagnosis of arrhythmia, such as atrial fibrillation, frequent ventricular or supraventricular premature beats,
5. diagnosis of heart failure or valvular disease,
6. anemia of hemoglobin < 12 g/dL,
7. incapable of surgery due to hemodynamic or medical reasons other than stated above,
8. incapable of receiving acupuncture treatment on determined location,
9. current use of gonadotropin-releasing hormone receptor agonists,
10. current use of drugs that may interfere with the result, including steroids, immunosuppressants, and psychiatric disorders,
11. significant comorbidities that may interfere with the interpretation of intervention efficacy or results, such as stroke, myocardial infarction, kidney disease, dementia, or epilepsy,
12. pregnant, planning to be pregnant within study period, or breastfeeding,
13. previous participation in any other clinical trial within 1 month of participation, planning to participate another clinical trial within 6 months after enrollment date, or planning to participate another clinical trial on follow-up period,
14. fail to write the informed consent form voluntarily,
15. being deemed to be unsuitable for participation.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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30 participants in 2 patient groups, including a placebo group

acupuncture group

Experimental group

Description:

A total 10 acupoints of bilateral PC6, PC5, SP3, KI3, and ST36 will be chosen for the intervention group, also known as the acupuncture group. The depth of acupuncture will be varied by participant by participant. After acupuncture needles be inserted, the needles will be manually manipulated to obtain pre-determined sensation, the De Qi. Then, acupuncture will remain inserted for 20 minutes.

Treatment:

Device: acupuncture

placebo group

Placebo Comparator group

Description:

Ten other points, which are not official acupoints and those are not on the median nerve or peroneal nerve, will be chosen for the placebo group.

Treatment:

Device: placebo acupuncture