Analgesics

Central Nervous System Depressants

All Drugs and Chemicals

Micronutrients

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Vitamins

Morphine

Vitamin A

Retinol palmitate

Analgesics, Opioid

Narcotics

Retinol

After G A and securing the tube in place , the patients will be placed in the lateral decubtious position and a single dose of intrathecal morphine will be performed using a 25 gauge needle (Brown ®,Germany) and free flow of CSF technique.children will receive intrathecal morphine 2 μg/kg in 2 ml volume normal saline.

After G A and securing the tube in place , the patients will be placed in the lateral decubtious position and a single dose of intrathecal morphine will be performed using a 25 gauge needle (Brown ®,Germany) and free flow of CSF technique. children will receive intrathecal morphine 5 μg/kg in 2 ml volume normal saline.

After G A and securing the tube in place , the patients will be placed in the lateral decubtious position and a single dose of intrathecal morphine will be performed using a 25 gauge needle (Brown ®,Germany) and free flow of CSF technique.children will receive intrathecal morphine 10 μg/kg in 2 ml volume normal saline.

intrathecal morphine

Postoperative pain in pediatrics can usually be well controlled with a combination of analgesics including acetaminophen ( paracetamol) ,NSIADS, opioids , and local/regional anesthesia.The use of epidural and subarachnoid morphine for analgesia in adults has grown almost as quickly as Morton's discovery of anesthesia in 1846. The application of these techniques to the pediatric patients has evolved much more slowly,although significant progress is being made by many investigators.

Advantage of intrathecal morphine as that extremely small doses of opioids are required when administrated intrathecally because they have direct access to spinal cord opioid receptors. Drug administered epidurally or caudally are required in much higher doses because they must first diffuse into the CSF before they reach spinal opioid receptors. As a result, the duration of action of intrathecal morphine is greater than that of single shot peridural techniques.

To investigate the safety and efficacy of intrathecal morphine in post operative pain relief in pediatric patients undergoing major abdominal cancer surgeries using different doses of intrathecal morphine (2 μg/kg , 5 μg/kg ,10μg/kg).

intratehcal injection of drug( morphine).

using opaque sealed envelopes containing computer generated randomization schedule, the opaque sealed envelopes are sequentially numbered that were open before application of anesthetic plan.

Safety and Efficacy of Intrathecal Morphine in Children

Safety and Efficacy of Intrathecal Morphine in Children Undergoing Major Abdominal Surgeries, Dose-finding Clinical Study

The face , Legs , Activity, Crying , and Consolability (FLACC) pain score with its 0- 10 score range will be used to assess pain

Alaa Ali Mohamed Elzohry

Lecturer in South Egypt Cancer Insitute

Neoplasms

Symptoms and General Pathology

All Conditions

Digestive System Diseases

Neoplasm Metastasis

Inflammation

Disease Progression

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Anti-Arrhythmia Agents

Channel Blockers

Anesthetics

Dexmedetomidine

Lidocaine

Anesthetics, Local

Sodium Channel Blockers

Diuretics, Potassium Sparing

Hypnotics and Sedatives

Analgesics, Non-Narcotic

Adrenergic Agents

Adrenergic alpha-Agonists

Adrenergic Agonists

Neurotransmitter Agents

A loading dose of 1.5mg/kg lidocaine will be infused for 10 minutes during anesthesia induction. During the surgery and post-anaesthesia care unit (PACU) stay, 1.5 mg/kg/h of lidocaine were continuously infused until the patient was transferred to the general ward.

A loading dose of 0.3mcg/kg dexmedetomidine will be infused for 10 minutes during anesthesia induction. During the surgery and PACU stay, 0.3 mcg/kg/h of dexmedetomidine were continuously infused until the patient was transferred to the general ward.

200\~300mcg of Intrathecal morphine will be injected at the anesthesia induction for colorectal surgery.

Continuous intravenous infusion of lidocaine

Lidocaine IV

Continuous intravenous infusion of dexmedetomidine

Dexmedetomidine IV

Mihye Park, MD, PhD

This is a prospective randomized controlled trial. Investigators aimed to compare the effect of three different anesthetic adjuvants (continuous infusion of lidocaine or dexmedetomidine, intrathecal morphine injection) on the biomarker for cancer recurrence and metastasis.

Patients undergoing elective colorectal cancer surgery will be randomly allocated to three parallel arms and the biomarkers for cancer recurrence and metastasis, inflammation, and immune response will be compared. And we will compare the clinical outcomes in the three method.

Perioperative period is critical in determining the risk of postoperative metastatic disease. Surgical damage and related stress response could suppress cell-mediated immunity and facilitate malignant cell survival, motility, invasion and proliferation. Increasing evidence supported that the continuous infusion of lidocaine or dexmedetomidine, or intrathecal morphine were associated with the reduction of postoperative pain and opioid consumption and improved the quality of recovery.

Also, they were reported to decrease perioperative inflammatory responses and preserve immune response which is known to be critical in anti-metastatic process during perioperative period. However, no comparison was conducted among these anesthetic adjuvants. Thus, Investigators try to evaluate the effect on the biomarkers and clinical outcomes in the three methods.

Effects of Dexmedetomidine/Lidocaine/Intrathecal Morphine on Cancer Metastasis Biomarker After Colorectal Surgery

Effect of Dexmedetomidine Infusion, Lidocaine Infusion, and Intrathecal Morphine Injection on Biomarker for Perioperative Stress and Immune Response, and Cancer Progression and Metastasis in Colorectal Cancer Surgery

CD3+CD4+ (inducer and helper T cells), CD3+CD8+ (suppressor and cytotoxic T cells), CD3-CD16+CD56+ (Natural killer cells), CD39+CD73+ (circulating regulatory T cells), CD73+CD8+ T cells, CD73+CD4+ T cells

Pain severity with numeric rating scale for postoperative pain, the value range (0\~10), a higher score means more painful

morphine equivalent unit of opioid consumption

from the end of surgery to the time of first flatus

from the end of surgery to patient discharge

according to the predetermined definition for postoperative pulmonary complications (atelectasis diagnosed by radiographic findings, diagnosed pneumonia)

need for in-and-out catheterization or reinsertion of an indwelling urinary catheter during the hospital stay after the original urinary catheter was removed, and re-operation

Korea Institute of Science and Technology

Samsung Medical Center

assistant professor

Nervous System Diseases

Pain, Postoperative

Pain

Postoperative Complications

Neurologic Manifestations

Bupivacaine

Ketamine

Anesthetics, Dissociative

Anesthetics, Intravenous

Anesthetics, General

Excitatory Amino Acid Antagonists

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine in 1 ml volume intrathecally.

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.1 mg/kg ketamine in 1ml volume intrathecally.

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg morphine plus 0.1 mg/kg of Ketamine in 1 ml volume intrathecally.

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.3 mg intrathecal morphine1 ml volume.

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and 0.1 mg/kg intrathecal ketamine in 1ml volume.

intrathecal ketamine

patients received 10 mg of hyperbaric bupivacaine 0.5% in 2 ml volume and intrathecal morphine + ketamine 0.3 mg and 0.1 mg/kg respectively in 1 ml volume.

intrathecal morphine + ketamine

this study investigates the analgesic efficacy and other possible effects of ketamine, morphine, and both together when administered intrathecally for control of postoperative pain following lower abdominal cancer surgeries.

intrathecaم Ketamine, Morphine and Both for Lower Abdominal Cancer Surgery Pain

Effects of Intrathecally Administered Ketamine, Morphine and Their Combination in Patients Undergoing Major Abdominal Cancer Surgery

postoperative pain measured by this score.

the time passed till the first request of rescue analgesia by the patients

the total amount of rescue analgesic drug used allover follow up period

the type and rate of incidence of side effects during the follow up period

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Safety and Efficacy of Intrathecal Morphine in Children	NCT03120403	Abdominal Cance...	intrathecal mor...	3 Years - 12 Years	Assiut University
Safety and Efficacy of Intrathecal Morphine in Children	NCT03120403	Abdominal Cance...	intrathecal mor...	3 Years - 12 Years	Assiut University
Effects of Dexmedetomidine/Lidocaine/Intrathecal Morphine on Cancer Metastasis Biomarker After Colorectal Surgery	NCT05742438	Colorectal Canc... Anesthesia Cancer Metastat... Inflammation	Lidocaine IV Dexmedetomidine... intrathecal mor...	19 Years -	Samsung Medical Center
intrathecaم Ketamine, Morphine and Both for Lower Abdominal Cancer Surgery Pain	NCT02726828	Postoperative P...	intrathecal mor... intrathecal ket... intrathecal mor...	30 Years - 50 Years	Assiut University
Effects of Dexmedetomidine/Lidocaine/Intrathecal Morphine on Cancer Metastasis Biomarker After Colorectal Surgery	NCT05742438	Colorectal Canc... Anesthesia Cancer Metastat... Inflammation	Lidocaine IV Dexmedetomidine... intrathecal mor...	19 Years -	Samsung Medical Center
Effects of Dexmedetomidine/Lidocaine/Intrathecal Morphine on Cancer Metastasis Biomarker After Colorectal Surgery	NCT05742438	Colorectal Canc... Anesthesia Cancer Metastat... Inflammation	Lidocaine IV Dexmedetomidine... intrathecal mor...	19 Years -	Samsung Medical Center

Spots Global Cancer Trial Database for intrathecal morphine