xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06003218</url>
    </required_header>
    <id_info>
      <org_study_id>2023-276</org_study_id>
      <nct_id>NCT06003218</nct_id>
    </id_info>
    <brief_title>Dexmedetomidine-esketamine for Percutaneous Radiofrequency Liver Ablation</brief_title>
    <official_title>Dexmedetomidine-esketamine Combined With Oxycodone for Ultrasound-guided Percutaneous Radiofrequency Ablation in Patients With Liver Cancer: a Randomized Controlled Study</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Peking University First Hospital</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Peking University First Hospital</source>
    <oversight_info>
      <has_dmc>Yes</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Percutaneous radiofrequency ablation is a commonly treatment for patients with liver cancer&#xD;
        that cannot be surgically resected. During the procedure, patients need to keep awake and&#xD;
        cooperate with the procedure, including deep breath and hold breath. However, intolerable&#xD;
        pain generated during puncture and radiofrequency heating may cause body movements and&#xD;
        interfere the procedure. Oxycodone is frequently used for analgesia but still insufficient. A&#xD;
        recent study showed that dexmedetomidine-esketamine combination improves analgesia without&#xD;
        increasing adverse events. After stopping infusion, the analgesic/sleep-promoting effects of&#xD;
        dexmedetomidine-esketamine seemed to last for up to 24 hours.&#xD;
  &#xD;
        The investigators hypothesize that dexmedetomidine-esketamine combination as a supplement to&#xD;
        oxycodone will improve sedation and analgesia in patients undergoing radiofrequency liver&#xD;
        ablation of the liver.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Ultrasound-guided percutaneous radiofrequency ablation is a new technique to treat liver&#xD;
        cancer. Under ultrasound guidance, a radiofrequency electrode needle is inserted into the&#xD;
        cancer through which local high temperature is generated to coagulate and necrose the cancer&#xD;
        tissue. Percutaneous radiofrequency ablation is currently recognized as the best treatment&#xD;
        for patients with liver cancer that cannot be surgically resected. During the procedure,&#xD;
        patients need to keep awake and cooperate with the procedure, including deep breath and hold&#xD;
        breath. However, intolerable pain generated during puncture and radiofrequency heating may&#xD;
        cause body movements and interfere the procedure.&#xD;
  &#xD;
        Oxycodone is a widely used opioid. It activates the μ and κ receptors and relieves pain&#xD;
        including visceral pain, which makes it suitable for analgesia during radiofrequency&#xD;
        ablation. However, due to the strong stimulation of radiofrequency liver ablation,&#xD;
        supplemental analgesics are often required to improve patient cooperation. As a commonly used&#xD;
        supplement, remifentanil is also a μ receptor agonist that quickly reaches blood-brain&#xD;
        balance in about 1 minute in and is rapidly hydrolyzed in tissues and blood. The problems&#xD;
        with remifentanil are the ultra-short action and pain allergy after stopping infusion. The&#xD;
        burning pain after percutaneous liver radiofrequency ablation may last for up to 24 hours.&#xD;
  &#xD;
        Dexmedetomidine is a highly selective α2-adrenergic receptor agonist that has sedative,&#xD;
        anxiolytic, and analgesic effects. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA)&#xD;
        receptor antagonist that is widely used in pediatric anesthesia and postoperative analgesia.&#xD;
        Recent studies found that low-dose ketamine also has antidepressant and sleep promoting&#xD;
        effects. Esketamine is the S-enantiomer of racemic ketamine with a higher affinity for NMDA&#xD;
        receptors and is approximately twice as potent as racemic ketamine in analgesia. A recent&#xD;
        study showed that dexmedetomidine-esketamine combination improves analgesia without&#xD;
        increasing adverse events. After stopping infusion, the analgesic and sleep-promoting effects&#xD;
        of dexmedetomidine-esketamine seemed to last for up to 24 hours.&#xD;
  &#xD;
        The investigators hypothesize that dexmedetomidine-esketamine combination as a supplement to&#xD;
        oxycodone will improve sedation and analgesia in patients undergoing radiofrequency liver&#xD;
        ablation of the liver.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">August 2023</start_date>
    <completion_date type="Anticipated">August 2024</completion_date>
    <primary_completion_date type="Anticipated">July 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Prevention</primary_purpose>
      <masking>Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Area under curve of Numerical Rating Scale of pain during and within 24 hours after surgery.</measure>
      <time_frame>During and within 24 hours after surgery.</time_frame>
      <description>Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain will be assessed after percutaneous liver puncture, start of radiofrequency-ablation, every 2 minutes during radiofrequency-ablation, end of radiofrequency-ablation, and 10 minutes after needle removal during surgery, as well as at 0.5, 1, 6, 12, and 24 hours after surgery.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>The highest Numerical Rating Scale of pain during surgery.</measure>
      <time_frame>During surgery.</time_frame>
      <description>Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain will be assessed after percutaneous liver puncture, start of radiofrequency-ablation, every 2 minutes during radiofrequency-ablation, end of radiofrequency-ablation, and 10 minutes after needle removal during surgery</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Number of intraoperative adjustment of study drug infusion rate.</measure>
      <time_frame>During surgery.</time_frame>
      <description>Number of adjustment of study drug infusion rate during surgery.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Number of additional oxycodone or other analgesics during and within 24 hours after surgery.</measure>
      <time_frame>During and within 24 hours after surgery.</time_frame>
      <description>Number of additional oxycodone or other analgesics during and within 24 hours after surgery.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Dose of analgesics during and within 24 hours after surgery.</measure>
      <time_frame>During and within 24 hours after surgery.</time_frame>
      <description>Dose of opioids (excluding remifentanil administered as study drugs) will be converted to intravenous morphine equivalent.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Pain intensity and opioid consumption (PIOC) index during and within 24 hours after surgery.</measure>
      <time_frame>During and within 24 hours after surgery.</time_frame>
      <description>Pain intensity will be calculated as area under curve (AUC) of Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain during and within 24 hours after surgery. Opioid consumption (OC) during and within 24 hours after surgery will be calculated after excluding remifentanil administered as study drugs. Pain intensity and opioid consumption (PIOC) index will be calculated as: PIOC=[(AUCmean rank - AUCrank)/AUCmean rank] + [(OCmean rank - OCrank)/OCmean rank]. The range of the sum is -200% to +200%. Values above 0 indicate increased summed AUC and OC compared to the all patients.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Numeric Rating Scale of subjective sleep quality on the first and second nights after surgery.</measure>
      <time_frame>On the first and second nights after surgery.</time_frame>
      <description>Numerical Rating Scale (NRS, an 11-point scale where 0=the best sleep and 10=the worst sleep) of sleep quality on the first and second nights after surgery.</description>
    </secondary_outcome>
    <other_outcome>
      <measure>Patients' evaluation on anesthesia.</measure>
      <time_frame>Within 30 minutes after surgery.</time_frame>
      <description>Patients' evaluation will be performed using the Likert five-point scale: 1=very dissatisfied, 2=dissatisfied, 3=neutral, 4=satisfied, and 5=very satisfied.</description>
    </other_outcome>
    <other_outcome>
      <measure>Surgeons' evaluation on anesthesia.</measure>
      <time_frame>Within 30 minutes after surgery.</time_frame>
      <description>Surgeons' evaluation will be performed using the Likert five-point scale: 1=very dissatisfied, 2=dissatisfied, 3=neutral, 4=satisfied, and 5=very satisfied.</description>
    </other_outcome>
    <other_outcome>
      <measure>Postoperative recovery time.</measure>
      <time_frame>Up to 2 hours after surgery.</time_frame>
      <description>Time interval between end of surgery and arrival of general ward.</description>
    </other_outcome>
    <other_outcome>
      <measure>Length of hospital stay after surgery.</measure>
      <time_frame>Up to 30 days after surgery.</time_frame>
      <description>Length of hospital stay after surgery.</description>
    </other_outcome>
    <other_outcome>
      <measure>Incidence of postoperative complications during hospital stay.</measure>
      <time_frame>Up to 30 days after surgery.</time_frame>
      <description>Postoperative complications are defined as new-onset conditions after surgery that have adverse effects on postoperative recovery and require therapeutic interventions.</description>
    </other_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">88</enrollment>
    <condition>Liver Cancer</condition>
    <condition>Radiofrequency Ablation</condition>
    <condition>Esketamine</condition>
    <condition>Dexmedetomidine</condition>
    <arm_group>
      <arm_group_label>Dexmedetomidine-esketamine combined with oxycodone</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Dexmedetomidine-esketamine combination will be infused in addition to oxycodone; the target is to maintain a Richmond Agitation and Sedation Scale between -2 and -1 during surgery.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Remifentanil combined with oxycodone</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Remifentanil will be infused in addition to oxycodone; the target is to maintain a Richmond Agitation and Sedation Scale between -2 and -1 during surgery.</description>
    </arm_group>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Dexmedetomidine-esketamine combination</intervention_name>
      <description>Dexmedetomidine-esketamine mixture will be infused with doses adjusted to maintain a Richmond Agitation-Sedation Scale between -2 to -1 during surgery.</description>
      <arm_group_label>Dexmedetomidine-esketamine combined with oxycodone</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Remifentanil</intervention_name>
      <description>Remifentanil will be infused with doses adjusted to maintain a Richmond Agitation-Sedation Scale between -2 to -1 during surgery.</description>
      <arm_group_label>Remifentanil combined with oxycodone</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Oxycodone</intervention_name>
      <description>Oxycodone will be injected intravenously 10-15 min before puncture.</description>
      <arm_group_label>Dexmedetomidine-esketamine combined with oxycodone</arm_group_label>
      <arm_group_label>Remifentanil combined with oxycodone</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            1. Aged ≥18 years but ≤85 years.&#xD;
  &#xD;
            2. Scheduled for elective ultrasound-guided percutaneous radiofrequency ablation for&#xD;
               primary or metastatic liver cancer.&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            1. Refused to participate.&#xD;
  &#xD;
            2. Diagnosed schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis before&#xD;
               surgery.&#xD;
  &#xD;
            3. Preoperative left ventricular ejection fraction (LVEF) &lt;30%, or those with sick sinus&#xD;
               syndrome, sinus bradycardia (heart rate &lt;50 beats per minute), or atrioventricular&#xD;
               block at grade II or above without pacemaker.&#xD;
  &#xD;
            4. Diagnosed obstructive sleep apnea (OSA) or judged to be at high-risk of&#xD;
               moderate-to-severe OSA before surgery.&#xD;
  &#xD;
            5. Severe liver dysfunction (Child-Pugh grade C), severe renal dysfunction (dialysis&#xD;
               before surgery), or classified as American Society of Anesthesiologists (ASA) grade&#xD;
               &gt;III before surgery.&#xD;
  &#xD;
            6. Inability to communicate due to coma, severe dementia, or language barrier before&#xD;
               surgery.&#xD;
  &#xD;
            7. Allergy to any drug used during the study, or other conditions that are considered&#xD;
               unsuitable for study participation.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>85 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Dong-Xin Wang, MD, PhD</last_name>
      <role>Principal Investigator</role>
      <affiliation>Peking University First Hospital</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Dong-Xin Wang, MD, PhD</last_name>
      <phone>86(10) 83572784</phone>
      <email>wangdongxin@hotmail.com</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Hong Hong, MD</last_name>
      <phone>+86 17810265121</phone>
      <email>honghong920066@sina.com</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>Peking University First Hospital</name>
        <address>
          <city>Beijing</city>
          <state>Beijing</state>
          <zip>100034</zip>
          <country>China</country>
        </address>
      </facility>
      <contact>
        <last_name>Dong-Xin Wang, MD, PhD</last_name>
        <phone>+861083572784</phone>
        <email>wangdongxin@hotmail.com</email>
      </contact>
    </location>
    <location_countries>
      <country>China</country>
    </location_countries>
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    <verification_date>August 2023</verification_date>
    <study_first_submitted>August 12, 2023</study_first_submitted>
    <study_first_submitted_qc>August 18, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 21, 2023</study_first_posted>
    <last_update_submitted>August 19, 2023</last_update_submitted>
    <last_update_submitted_qc>August 19, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 22, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Peking University First Hospital</investigator_affiliation>
      <investigator_full_name>Dong-Xin Wang</investigator_full_name>
      <investigator_title>Professor and Chairman, Department of Anesthesiology</investigator_title>
    </responsible_party>
    <keyword>Liver cancer</keyword>
    <keyword>Radiofrequency ablation</keyword>
    <keyword>Esketamine</keyword>
    <keyword>Dexmedetomidine</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Liver Neoplasms</mesh_term>
    </condition_browse>
    <intervention_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Dexmedetomidine</mesh_term>
      <mesh_term>Remifentanil</mesh_term>
      <mesh_term>Oxycodone</mesh_term>
      <mesh_term>Esketamine</mesh_term>
    </intervention_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06003218
  org study id: 2023-276
  nct id: NCT06003218
  lead sponsor: 
  has dmc: Yes
  is fda regulated drug: No
  is fda regulated device: No
  Percutaneous radiofrequency ablation is a commonly treatment for patients with liver cancer
        that cannot be surgically resected. During the procedure, patients need to keep awake and
        cooperate with the procedure, including deep breath and hold breath. However, intolerable
        pain generated during puncture and radiofrequency heating may cause body movements and
        interfere the procedure. Oxycodone is frequently used for analgesia but still insufficient. A
        recent study showed that dexmedetomidine-esketamine combination improves analgesia without
        increasing adverse events. After stopping infusion, the analgesic/sleep-promoting effects of
        dexmedetomidine-esketamine seemed to last for up to 24 hours.
  
        The investigators hypothesize that dexmedetomidine-esketamine combination as a supplement to
        oxycodone will improve sedation and analgesia in patients undergoing radiofrequency liver
        ablation of the liver.
  Ultrasound-guided percutaneous radiofrequency ablation is a new technique to treat liver
        cancer. Under ultrasound guidance, a radiofrequency electrode needle is inserted into the
        cancer through which local high temperature is generated to coagulate and necrose the cancer
        tissue. Percutaneous radiofrequency ablation is currently recognized as the best treatment
        for patients with liver cancer that cannot be surgically resected. During the procedure,
        patients need to keep awake and cooperate with the procedure, including deep breath and hold
        breath. However, intolerable pain generated during puncture and radiofrequency heating may
        cause body movements and interfere the procedure.
  
        Oxycodone is a widely used opioid. It activates the μ and κ receptors and relieves pain
        including visceral pain, which makes it suitable for analgesia during radiofrequency
        ablation. However, due to the strong stimulation of radiofrequency liver ablation,
        supplemental analgesics are often required to improve patient cooperation. As a commonly used
        supplement, remifentanil is also a μ receptor agonist that quickly reaches blood-brain
        balance in about 1 minute in and is rapidly hydrolyzed in tissues and blood. The problems
        with remifentanil are the ultra-short action and pain allergy after stopping infusion. The
        burning pain after percutaneous liver radiofrequency ablation may last for up to 24 hours.
  
        Dexmedetomidine is a highly selective α2-adrenergic receptor agonist that has sedative,
        anxiolytic, and analgesic effects. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA)
        receptor antagonist that is widely used in pediatric anesthesia and postoperative analgesia.
        Recent studies found that low-dose ketamine also has antidepressant and sleep promoting
        effects. Esketamine is the S-enantiomer of racemic ketamine with a higher affinity for NMDA
        receptors and is approximately twice as potent as racemic ketamine in analgesia. A recent
        study showed that dexmedetomidine-esketamine combination improves analgesia without
        increasing adverse events. After stopping infusion, the analgesic and sleep-promoting effects
        of dexmedetomidine-esketamine seemed to last for up to 24 hours.
  
        The investigators hypothesize that dexmedetomidine-esketamine combination as a supplement to
        oxycodone will improve sedation and analgesia in patients undergoing radiofrequency liver
        ablation of the liver.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Prevention
  masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  measure: Area under curve of Numerical Rating Scale of pain during and within 24 hours after surgery.
  time frame: During and within 24 hours after surgery.
  description: Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain will be assessed after percutaneous liver puncture, start of radiofrequency-ablation, every 2 minutes during radiofrequency-ablation, end of radiofrequency-ablation, and 10 minutes after needle removal during surgery, as well as at 0.5, 1, 6, 12, and 24 hours after surgery.
  measure: The highest Numerical Rating Scale of pain during surgery.
  time frame: During surgery.
  description: Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain will be assessed after percutaneous liver puncture, start of radiofrequency-ablation, every 2 minutes during radiofrequency-ablation, end of radiofrequency-ablation, and 10 minutes after needle removal during surgery
  measure: Number of intraoperative adjustment of study drug infusion rate.
  time frame: During surgery.
  description: Number of adjustment of study drug infusion rate during surgery.
  measure: Number of additional oxycodone or other analgesics during and within 24 hours after surgery.
  time frame: During and within 24 hours after surgery.
  description: Number of additional oxycodone or other analgesics during and within 24 hours after surgery.
  measure: Dose of analgesics during and within 24 hours after surgery.
  time frame: During and within 24 hours after surgery.
  description: Dose of opioids (excluding remifentanil administered as study drugs) will be converted to intravenous morphine equivalent.
  measure: Pain intensity and opioid consumption (PIOC) index during and within 24 hours after surgery.
  time frame: During and within 24 hours after surgery.
  description: Pain intensity will be calculated as area under curve (AUC) of Numerical Rating Scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) of pain during and within 24 hours after surgery. Opioid consumption (OC) during and within 24 hours after surgery will be calculated after excluding remifentanil administered as study drugs. Pain intensity and opioid consumption (PIOC) index will be calculated as: PIOC=[(AUCmean rank - AUCrank)/AUCmean rank] + [(OCmean rank - OCrank)/OCmean rank]. The range of the sum is -200% to +200%. Values above 0 indicate increased summed AUC and OC compared to the all patients.
  measure: Numeric Rating Scale of subjective sleep quality on the first and second nights after surgery.
  time frame: On the first and second nights after surgery.
  description: Numerical Rating Scale (NRS, an 11-point scale where 0=the best sleep and 10=the worst sleep) of sleep quality on the first and second nights after surgery.
  measure: Patients' evaluation on anesthesia.
  time frame: Within 30 minutes after surgery.
  description: Patients' evaluation will be performed using the Likert five-point scale: 1=very dissatisfied, 2=dissatisfied, 3=neutral, 4=satisfied, and 5=very satisfied.
  measure: Surgeons' evaluation on anesthesia.
  time frame: Within 30 minutes after surgery.
  description: Surgeons' evaluation will be performed using the Likert five-point scale: 1=very dissatisfied, 2=dissatisfied, 3=neutral, 4=satisfied, and 5=very satisfied.
  measure: Postoperative recovery time.
  time frame: Up to 2 hours after surgery.
  description: Time interval between end of surgery and arrival of general ward.
  measure: Length of hospital stay after surgery.
  time frame: Up to 30 days after surgery.
  description: Length of hospital stay after surgery.
  measure: Incidence of postoperative complications during hospital stay.
  time frame: Up to 30 days after surgery.
  description: Postoperative complications are defined as new-onset conditions after surgery that have adverse effects on postoperative recovery and require therapeutic interventions.
  arm group label: Dexmedetomidine-esketamine combined with oxycodone
  arm group type: Experimental
  description: Dexmedetomidine-esketamine combination will be infused in addition to oxycodone; the target is to maintain a Richmond Agitation and Sedation Scale between -2 and -1 during surgery.
  arm group label: Remifentanil combined with oxycodone
  arm group type: Active Comparator
  description: Remifentanil will be infused in addition to oxycodone; the target is to maintain a Richmond Agitation and Sedation Scale between -2 and -1 during surgery.
  intervention type: Drug
  intervention name: Dexmedetomidine-esketamine combination
  description: Dexmedetomidine-esketamine mixture will be infused with doses adjusted to maintain a Richmond Agitation-Sedation Scale between -2 to -1 during surgery.
  arm group label: Dexmedetomidine-esketamine combined with oxycodone
  intervention type: Drug
  intervention name: Remifentanil
  description: Remifentanil will be infused with doses adjusted to maintain a Richmond Agitation-Sedation Scale between -2 to -1 during surgery.
  arm group label: Remifentanil combined with oxycodone
  intervention type: Drug
  intervention name: Oxycodone
  description: Oxycodone will be injected intravenously 10-15 min before puncture.
  arm group label: Dexmedetomidine-esketamine combined with oxycodone
  arm group label: Remifentanil combined with oxycodone
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 85 Years
  healthy volunteers: No
  last name: Dong-Xin Wang, MD, PhD
  role: Principal Investigator
  affiliation: Peking University First Hospital
  last name: Dong-Xin Wang, MD, PhD
  phone: 86(10) 83572784
  email: wangdongxin@hotmail.com
  last name: Hong Hong, MD
  phone: +86 17810265121
  email: honghong920066@sina.com
  facility: 
  contact: 
  country: China
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  responsible party type: Principal Investigator
  investigator affiliation: Peking University First Hospital
  investigator full name: Dong-Xin Wang
  investigator title: Professor and Chairman, Department of Anesthesiology
  mesh term: Liver Neoplasms
  mesh term: Dexmedetomidine
  mesh term: Remifentanil
  mesh term: Oxycodone
  mesh term: Esketamine