None listed
Conditions
Brief summary
To evaluate whether local anaesthetic running via a catheter in the abdominal wall improves analgesia following abdominal surgery
Interventions
Ropivacaine Transversus Abdominis Plane infusion at a rate of 0.1ml/kg/hr bilaterally up to a maximum of 7ml/hr bilaterally via transversus abdominis plane catheter for 48 hours. The infusion rate will be rounded down to the nearest integer (e.g. a 68 kg patient will receive an infusion rate of 6 ml/hr bilaterally).
Sponsors
Western Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients age 18 years or over. Elective or semi-elective surgery requiring a mid-line abdominal incision. Planned intraoperative Transversus Abdominis Plane blocks and postoperative morphine patient controlled analgesia.
Exclusion criteria
Plan for epidural and/or spinal analgesia. Surgeon or anaesthetist refusal to placement of catheters. Inability to communicate in English due to a language barrier, cognitive deficit or intellectual disability. Inability of patient to use patient controlled analgesia (PCA) pump postoperatively or to understand visual analogue pain score. Patients flagged for postoperative ventilation. Asthma if exacerbated by non-steroidal anti-inflammatory drugs (NSAIDs) or asthma if a patient has never taken a NSAID. Acute abdomen, with clinical signs of abdominal peritonism. Septicaemia involving positive bacterial blood cultures. Localised infection at the site of proposed needle insertion. Opioid tolerant patients, i.e. any of the following: -Patient taking an average of 8 Panadeine Forte tablets per day for a greater than one week. -Patients taking greater than 40 mg oxycodone per day for greater than one week. -Patients receiving 20 mg morphine parenterally per day for greater than one week. -Patients on a fentanyl patch of dose greater than 12.5 mcg/hour for greater than one week. -Any patient receiving buprenorphine. -Any patient receiving methadone. -Any patient receiving naltrexone or naloxone as part of an opioid abstinence program. Any history of injected or inhaled illicit drug use in the previous six months. A clinical history of chronic pain, where patients may benefit from early commencement of ketamine. Renal impairment with creatinine clearance less than 60 mL/min. Severe hepatic impairment (Child-Pugh score greater than or equal to 10). Patients with unstable or uncontrolled epilepsy. Allergy or contraindication to morphine, ropivacaine, tramadol, parocoxib, sulphonamides or paracetamol. Patients on ketaconazole, fluconazole, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), serotonin noradradrenaline reuptake inhibitors (SNRIs), tricyclic anti-depressents, carbemazepine, quinidine, antipsychotics, zidovudine or warfarin.
Outcome results
None listed