Mini-dose Dexmedetomidine-Esketamine Infusion and Perioperative Sleep Quality

NCT05950646 | Recruiting Phase 4 DMC

• 1 other identifier: 2023-239
• Study Type: interventional
• Target: 154
• Locations: 1 country
• Sites: 2

Brief Summary

Sleep disturbances are prevalent in older patients with osteoarthrosis or fracture who are scheduled for knee or hip replacement surgery. The occurrence of sleep disturbances is associated with worse outcomes including increased risk of delirium and cardiac events, and worsened functional recovery. Dexmedetomidine is a highly selective α2-adrenergic agonist with sedative, anxiolytic, and analgesic properties. It exerts sedative effects via activating the endogenous sleep pathways and produces a state like non-rapid eye movement sleep, which is different from opioid- and benzodiazepine-induced sedation. Esketamine is a N-methyl-D-aspartic acid receptor antagonist and has been used as an anesthetic and analgesic. Recent studies showed that low-dose esketamine has anti-depressive and sleep-promoting effects. The investigators suppose that mini-dose dexmedetomidine-esketamine combined infusion at night can improve perioperative sleep quality in patients scheduled for knee or hip replacement surgery.

Conditions

Old Age; Knee Replacement Surgery; Hip Replacement Surgery; Dexmedetomidine; Esketamine; Sleep Quality

Keywords

Old Age; Knee Replacement Surgery; Hip Replacement Surgery; Dexmedetomidine; Esketamine; Sleep Quality

Outcome Measures

Primary Outcomes (1)

• Subjective sleep quality in the night of surgery.

  Subjective sleep quality will be assessed in the next morning (between 8:00 am to 10:00 am) with the Richards-Campbell Sleep Questionnaire (RCSQ). The RCSQ is a self-reported measure that evaluated perception of nighttime sleep in five items, including sleep depth, sleep latency, number of awakenings, returning to sleep, and overall sleep quality. Each item was assessed with a 100-millimeter visual analog scale (score ranges from 0 to 100, with higher scores representing better sleep). The mean score of the five items represents the overall RCSQ score.

  The night on the day of surgery.

Secondary Outcomes (5)

• Total sleep time per night during the perioperative period.

  From the night before surgery until the second night after surgery.

• Sleep efficiency per night during the perioperative period.

  From the night before surgery until the second night after surgery.

• Sleep onset latency per night during the perioperative period.

  From the night before surgery until the second night after surgery.

• Wake after sleep onset per night during the perioperative period.

  From the night before surgery until the second night after surgery.

• Subjective sleep quality during the perioperative period.

  From the night before surgery until the fifth night after surgery.

Other Outcomes (9)

• Cerebrospinal fluid and blood proteomics examination (selected patients).

  During anesthesia.

• Intensity of pain during the first 5 postoperative days.

  Up to 5 days after surgery.

• Use of supplemental analgesics

  Up to 5 days after surgery.

Study Arms (2)

Dexmedetomidine-esketamine combination

EXPERIMENTAL

Dexmedetomidine-esketamine combination will be infused at a rate of 0.01 ml/kg/h (dexmedetomidine 0.02 μg/kg/h and esketamine 5 μg/kg/h) from 8 pm in the night before surgery until 8 am in the third morning after surgery.

Drug: Dexmedetomidine; Drug: Esketamine

Normal saline

PLACEBO COMPARATOR

Placebo (normal saline) will be infused at a rate of 0.01 ml/kg/h from 8 pm in the night before surgery until 8 am in the third morning after surgery.

Drug: Normal saline

Interventions

Dexmedetomidine DRUG

Dexmedetomidine will be infused at a rate of 0.01 ml/ kg/h (0.02 μg/kg/h) from 8 pm in the night before surgery until 8 am in the third morning after surgery.

Dexmedetomidine-esketamine combination

Esketamine DRUG

Esketamine will be infused at a rate of 0.01 ml/ kg/h (5 μg/kg/h) from 8 pm in the night before surgery until 8 am in the third morning after surgery.

Dexmedetomidine-esketamine combination

Normal saline DRUG

Normal saline will be infused at a rate of 0.01 ml/ kg/h from 8 pm in the night before surgery until 8 am in the third morning after surgery.

Normal saline

Eligibility Criteria

• Age: 65 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Age ≥65 years and \<90 years;
• Scheduled to undergo unilateral knee or hip arthroplasty.

You may not qualify if:

• Refuse to participate;
• Hypnotic therapy for sleep disorders within 3 months;
• Preoperative history of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis;
• Diagnosed as obstructive sleep apnea, or at high risk of moderate to severe obstructive sleep apnea according to the Stop-Bang questionnaire;
• Inability to communicate in the preoperative period because of coma, profound dementia, or language barrier;
• Sick sinus syndrome, severe sinus bradycardia (heart rate \<50 beats/min), or atrioventricular block above grade II without pacemaker implanted;
• Severe hepatic dysfunction (Child-Pugh class C), renal dysfunction (required preoperative dialysis), or expected survival ≤24 hours;
• Receiving treatment with dexmedetomidine, clonidine, or esketamine;
• Allergy to dexmedetomidine or esketamine.

Sponsors & Collaborators

• Peking University First Hospital: lead
• Beijing Hospital: collaborator

Study Sites (2)

Beijing Hospital

Beijing, Beijing Municipality, 100005, China

RECRUITING

Peking University First Hospital

Beijing, Beijing Municipality, 100034, China

RECRUITING

Related Publications (41)

• Siegel JM. Sleep viewed as a state of adaptive inactivity. Nat Rev Neurosci. 2009 Oct;10(10):747-53. doi: 10.1038/nrn2697. Epub 2009 Aug 5.

  PMID: 19654581 BACKGROUND

• Berry RB. Fundamentals of sleep medicine. Philadelphia: Elsevier Saunders; 2012.

  BACKGROUND

• Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224.

  PMID: 24136970 BACKGROUND

• Ratner V, Gao Y, Lee H, Elkin R, Nedergaard M, Benveniste H, Tannenbaum A. Cerebrospinal and interstitial fluid transport via the glymphatic pathway modeled by optimal mass transport. Neuroimage. 2017 May 15;152:530-537. doi: 10.1016/j.neuroimage.2017.03.021. Epub 2017 Mar 18.

  PMID: 28323163 BACKGROUND

• Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol. 2019 Nov;19(11):702-715. doi: 10.1038/s41577-019-0190-z.

  PMID: 31289370 BACKGROUND

• Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004 Nov 1;27(7):1255-73. doi: 10.1093/sleep/27.7.1255.

  PMID: 15586779 BACKGROUND

• Sundbom F, Janson C, Malinovschi A, Lindberg E. Effects of Coexisting Asthma and Obstructive Sleep Apnea on Sleep Architecture, Oxygen Saturation, and Systemic Inflammation in Women. J Clin Sleep Med. 2018 Feb 15;14(2):253-259. doi: 10.5664/jcsm.6946.

  PMID: 29394961 BACKGROUND

• Andrechuk CR, Ceolim MF. Sleep quality and adverse outcomes for patients with acute myocardial infarction. J Clin Nurs. 2016 Jan;25(1-2):223-30. doi: 10.1111/jocn.13051.

  PMID: 26769209 BACKGROUND

• Onen SH, Onen F, Courpron P, Dubray C. How pain and analgesics disturb sleep. Clin J Pain. 2005 Sep-Oct;21(5):422-31. doi: 10.1097/01.ajp.0000129757.31856.f7.

  PMID: 16093748 BACKGROUND

• Lintzeris N, Moodley R, Campbell G, Larance B, Bruno R, Nielsen S, Degenhardt L. Sleep Quality Among People Living With Chronic Noncancer Pain: Findings From the Pain and Opioids IN Treatment (POINT) Cohort. Clin J Pain. 2016 May;32(5):380-7. doi: 10.1097/AJP.0000000000000282.

  PMID: 26218004 BACKGROUND

• Er MS, Altinel EC, Altinel L, Erten RA, Eroglu M. An assessment of sleep quality in patients undergoing total knee arthroplasty before and after surgery. Acta Orthop Traumatol Turc. 2014;48(1):50-4. doi: 10.3944/AOTT.2014.3163.

  PMID: 24643100 BACKGROUND

• Sasaki E, Tsuda E, Yamamoto Y, Maeda S, Inoue R, Chiba D, Okubo N, Takahashi I, Nakaji S, Ishibashi Y. Nocturnal knee pain increases with the severity of knee osteoarthritis, disturbing patient sleep quality. Arthritis Care Res (Hoboken). 2014 Jul;66(7):1027-32. doi: 10.1002/acr.22258.

  PMID: 24470323 BACKGROUND

• Rampes S, Ma K, Divecha YA, Alam A, Ma D. Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res. 2019 Aug 29;34(4):271-280. doi: 10.7555/JBR.33.20190054.

  PMID: 32519977 BACKGROUND

• Gogenur I, Wildschiotz G, Rosenberg J. Circadian distribution of sleep phases after major abdominal surgery. Br J Anaesth. 2008 Jan;100(1):45-9. doi: 10.1093/bja/aem340. Epub 2007 Nov 23.

  PMID: 18037670 BACKGROUND

• Yilmaz H, Iskesen I. Follow-up with objective and subjective tests of the sleep characteristics of patients after cardiac surgery. Circ J. 2007 Oct;71(10):1506-10. doi: 10.1253/circj.71.1506.

  PMID: 17895541 BACKGROUND

• Knill RL, Moote CA, Skinner MI, Rose EA. Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week. Anesthesiology. 1990 Jul;73(1):52-61. doi: 10.1097/00000542-199007000-00009.

  PMID: 2360740 BACKGROUND

• Fatah RMN, Abdulrahman BB. A sleep disturbance after total knee arthroplasty. J Family Med Prim Care. 2020 Jan 28;9(1):119-124. doi: 10.4103/jfmpc.jfmpc_595_19. eCollection 2020 Jan.

  PMID: 32110576 BACKGROUND

• Mukartihal RK, Angadi DS, Mangukiya HJ, Singh NK, Varad S, Ramesh PA, Patil SS. Temporal changes in sleep quality and knee function following primary total knee arthroplasty: a prospective study. Int Orthop. 2022 Feb;46(2):223-230. doi: 10.1007/s00264-021-05192-1. Epub 2021 Aug 27.

  PMID: 34453191 BACKGROUND

• Sipila RM, Kalso EA. Sleep Well and Recover Faster with Less Pain-A Narrative Review on Sleep in the Perioperative Period. J Clin Med. 2021 May 7;10(9):2000. doi: 10.3390/jcm10092000.

  PMID: 34066965 BACKGROUND

• Bjurstrom MF, Irwin MR, Bodelsson M, Smith MT, Mattsson-Carlgren N. Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty. Eur J Pain. 2021 Aug;25(7):1482-1492. doi: 10.1002/ejp.1761. Epub 2021 Mar 23.

  PMID: 33682177 BACKGROUND

• Slatore CG, Goy ER, O'hearn DJ, Boudreau EA, O'Malley JP, Peters D, Ganzini L. Sleep quality and its association with delirium among veterans enrolled in hospice. Am J Geriatr Psychiatry. 2012 Apr;20(4):317-26. doi: 10.1097/JGP.0b013e3182487680.

  PMID: 22367162 BACKGROUND

• Cho MR, Song SK, Ryu CH. Sleep Disturbance Strongly Related to the Development of Postoperative Delirium in Proximal Femoral Fracture Patients Aged 60 or Older. Hip Pelvis. 2020 Jun;32(2):93-98. doi: 10.5371/hp.2020.32.2.93. Epub 2020 Jun 15.

  PMID: 32566540 BACKGROUND

• Hunt JO, Hendrata MV, Myles PS. Quality of life 12 months after coronary artery bypass graft surgery. Heart Lung. 2000 Nov-Dec;29(6):401-11. doi: 10.1067/mhl.2000.110578.

  PMID: 11080320 BACKGROUND

• Fernandes NM, Nield LE, Popel N, Cantor WJ, Plante S, Goldman L, Prabhakar M, Manlhiot C, McCrindle BW, Miner SE. Symptoms of disturbed sleep predict major adverse cardiac events after percutaneous coronary intervention. Can J Cardiol. 2014 Jan;30(1):118-24. doi: 10.1016/j.cjca.2013.07.009. Epub 2013 Oct 16.

  PMID: 24140074 BACKGROUND

• Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5.

  PMID: 26063213 BACKGROUND

• Alexopoulou C, Kondili E, Diamantaki E, Psarologakis C, Kokkini S, Bolaki M, Georgopoulos D. Effects of dexmedetomidine on sleep quality in critically ill patients: a pilot study. Anesthesiology. 2014 Oct;121(4):801-7. doi: 10.1097/ALN.0000000000000361.

  PMID: 24988068 BACKGROUND

• Wu XH, Cui F, Zhang C, Meng ZT, Wang DX, Ma J, Wang GF, Zhu SN, Ma D. Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: A Pilot Randomized Controlled Trial. Anesthesiology. 2016 Nov;125(5):979-991. doi: 10.1097/ALN.0000000000001325.

  PMID: 27571256 BACKGROUND

• Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, Zhu X, Zhu SN, Maze M, Ma D. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016 Oct 15;388(10054):1893-1902. doi: 10.1016/S0140-6736(16)30580-3. Epub 2016 Aug 16.

  PMID: 27542303 BACKGROUND

• Zhang DF, Su X, Meng ZT, Li HL, Wang DX, Xue-Ying Li, Maze M, Ma D. Impact of Dexmedetomidine on Long-term Outcomes After Noncardiac Surgery in Elderly: 3-Year Follow-up of a Randomized Controlled Trial. Ann Surg. 2019 Aug;270(2):356-363. doi: 10.1097/SLA.0000000000002801.

  PMID: 29742525 BACKGROUND

• Li HJ, Li CJ, Wei XN, Hu J, Mu DL, Wang DX. Dexmedetomidine in combination with morphine improves postoperative analgesia and sleep quality in elderly patients after open abdominal surgery: A pilot randomized control trial. PLoS One. 2018 Aug 14;13(8):e0202008. doi: 10.1371/journal.pone.0202008. eCollection 2018.

  PMID: 30106963 BACKGROUND

• Zhang ZF, Su X, Zhao Y, Zhong CL, Mo XQ, Zhang R, Wang K, Zhu SN, Shen YE, Zhang C, Wang DX. Effect of mini-dose dexmedetomidine supplemented intravenous analgesia on sleep structure in older patients after major noncardiac surgery: A randomized trial. Sleep Med. 2023 Feb;102:9-18. doi: 10.1016/j.sleep.2022.12.006. Epub 2022 Dec 20.

  PMID: 36587547 BACKGROUND

• Persson J, Hasselstrom J, Maurset A, Oye I, Svensson JO, Almqvist O, Scheinin H, Gustafsson LL, Almqvist O. Pharmacokinetics and non-analgesic effects of S- and R-ketamines in healthy volunteers with normal and reduced metabolic capacity. Eur J Clin Pharmacol. 2002 Feb;57(12):869-75. doi: 10.1007/s002280100353.

  PMID: 11936706 BACKGROUND

• Wang M, Zhang B, Zhou Y, Wang C, Zheng W, Liu W, Zhan Y, Lan X, Ning Y. Sleep improvement is associated with the antidepressant efficacy of repeated-dose ketamine and serum BDNF levels: a post-hoc analysis. Pharmacol Rep. 2021 Apr;73(2):594-603. doi: 10.1007/s43440-020-00203-1. Epub 2021 Jan 2.

  PMID: 33387333 BACKGROUND

• Duncan WC, Sarasso S, Ferrarelli F, Selter J, Riedner BA, Hejazi NS, Yuan P, Brutsche N, Manji HK, Tononi G, Zarate CA. Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder. Int J Neuropsychopharmacol. 2013 Mar;16(2):301-11. doi: 10.1017/S1461145712000545. Epub 2012 Jun 7.

  PMID: 22676966 BACKGROUND

• Bunney BG, Li JZ, Walsh DM, Stein R, Vawter MP, Cartagena P, Barchas JD, Schatzberg AF, Myers RM, Watson SJ, Akil H, Bunney WE. Circadian dysregulation of clock genes: clues to rapid treatments in major depressive disorder. Mol Psychiatry. 2015 Feb;20(1):48-55. doi: 10.1038/mp.2014.138. Epub 2014 Nov 4.

  PMID: 25349171 BACKGROUND

• Bornemann-Cimenti H, Wejbora M, Michaeli K, Edler A, Sandner-Kiesling A. The effects of minimal-dose versus low-dose S-ketamine on opioid consumption, hyperalgesia, and postoperative delirium: a triple-blinded, randomized, active- and placebo-controlled clinical trial. Minerva Anestesiol. 2016 Oct;82(10):1069-1076. Epub 2016 Jun 21.

  PMID: 27327855 BACKGROUND

• Lee KH, Lee SJ, Park JH, Kim SH, Lee H, Oh DS, Kim YH, Park YH, Kim H, Lee SE. Analgesia for spinal anesthesia positioning in elderly patients with proximal femoral fractures: Dexmedetomidine-ketamine versus dexmedetomidine-fentanyl. Medicine (Baltimore). 2020 May;99(20):e20001. doi: 10.1097/MD.0000000000020001.

  PMID: 32443302 BACKGROUND

• Gong L, Wang Z, Fan D. Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA)--A Randomized, Double-Blind, Controlled Study. J Arthroplasty. 2015 Nov;30(11):1897-901. doi: 10.1016/j.arth.2015.02.020. Epub 2015 Feb 24.

  PMID: 26344094 BACKGROUND

• Shen SP, Wang YJ, Zhang Q, Qiang H, Weng XS. Improved Perioperative Sleep Quality or Quantity Reduces Pain after Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg. 2021 Jun;13(4):1389-1397. doi: 10.1111/os.12985.

  PMID: 34251091 BACKGROUND

• Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018 Jul;43(5):456-466. doi: 10.1097/AAP.0000000000000806.

  PMID: 29870457 BACKGROUND

• Chen LX, Ji DH, Zhang F, Li JH, Cui L, Bai CJ, Liu H, Liang Y. Richards-Campbell sleep questionnaire: psychometric properties of Chinese critically ill patients. Nurs Crit Care. 2019 Nov;24(6):362-368. doi: 10.1111/nicc.12357. Epub 2018 Jul 30.

  PMID: 30062842 BACKGROUND

MeSH Terms

Conditions

Sleep Initiation and Maintenance Disorders

Interventions

Dexmedetomidine; Esketamine; Saline Solution

Condition Hierarchy (Ancestors)

Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases; Mental Disorders

Intervention Hierarchy (Ancestors)

Imidazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Crystalloid Solutions; Isotonic Solutions; Solutions; Pharmaceutical Preparations

Study Officials

• Dong-Xin Wang, MD,PhD

  Peking University First Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dong-Xin Wang, MD,PhD

CONTACT

86 10 83572784; wangdongxin@hotmail.com

Shuang-Jie Cao, MD

CONTACT

+86 13651119431; caosjie@bjmu.edu.cn

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: July 11, 2023
• First Posted: July 18, 2023
• Study Start: November 1, 2023
• Primary Completion: November 1, 2025
• Study Completion: December 1, 2025
• Last Updated: July 30, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

CN (2)