Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial

Hewson, David W.; Worcester, Frank; Sprinks, James; Smith, Murray D.; Buchanan, Heather; Breedon, Philip; Hardman, Jonathan G.; Bedforth, Nigel M.

Abstract

Background
The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation.

Methods
The trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled.

Discussion
This is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting.

Citation

Hewson, D. W., Worcester, F., Sprinks, J., Smith, M. D., Buchanan, H., Breedon, P., Hardman, J. G., & Bedforth, N. M. (2019). Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial. Trials, 20(1), Article 129. https://doi.org/10.1186/s13063-019-3228-4

• Journal Article Type: Article
• Acceptance Date: Jan 29, 2019
• Online Publication Date: Feb 13, 2019
• Publication Date: 2019-12
• Deposit Date: Aug 19, 2019
• Publicly Available Date: Aug 21, 2019
• Journal: Trials
• Electronic ISSN: 1745-6215
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 1
• Article Number: 129
• DOI: https://doi.org/10.1186/s13063-019-3228-4
• Keywords: Propofol sedation, Patient-maintained propofol sedation, Regional anaesthesia, Joint arthroplasty, Procedural sedation
• Public URL: https://nottingham-repository.worktribe.com/output/2447188
• Publisher URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374891/
• Contract Date: Aug 21, 2019