Right Lobe Hepatectomy
Conditions
Keywords
Thoracic paravertebral block, Postoperative pain, Right lobe hepatectomy, Patient controlled analgesia
Brief summary
Patients often experience moderate to severe postoperative pain, especially during the first hours after hepatectomy. Systemic opioids given with patient-controlled analgesia has be used after hepatectomy in many medical center(Aubrun, Monsel et al. 2001; Aubrun, Salvi et al. 2005), but the analgesic effect can be limited and undesirable side effects may occur. A case report described that right thoracic paravertebral block reduced pain and analgesic requirements after right lobe hepatectomy(Ho, Karmakar et al. 2004). Compared with epidural analgesia, thoracic paravertebral block probably carries a much lower risk of spinal haematoma in the presence of moderate haemostatic deficiencies (Richardson and Lonnqvist 1998; Karmakar 2001). We therefore designed a prospective, randomized, subject and assessor blinded, parallel-group, placebo controlled study to test the hypothesis that continuous right thoracic paravertebral analgesia decreases opioid consumption during the first 24 h after right lobe hepatectomy in patients receiving i.v. patient-controlled analgesia (PCA) with sufentanil.
Interventions
Before anesthesia, continuous right thoracic paravertebral block of T7 is performed. After injection of 5 mL normal saline, a catheter (PAJUNK, Geisingen, Germany) is advanced medially the estimated distance to the paravertebral space. After injection of 1% lidocaine 15ml, the block level is tested by pinprick and recorded 15 minutes later. At the end of operation, syringe contained 0.2% ropivacaine is connected to paravertebral catheter, a 10ml bolus of 0.2% ropivacaine is injected via the paravertebral catheter, followed by an infusion of ropivacaine 0.2% at 6 ml/h for postoperative pain management.
PROCEDUREPatient-controlled analgesia with sufentanil
Once arrival at the PACU, all patients were placed on a postoperative analgesic regimen that included patient-controlled analgesia with intravenous sufentanil (bolus 1μg, lockout time 10 min) and tramadol 100 mg IV for severe pain (NRS 6-10).
Before anesthesia, continuous right thoracic paravertebral block of T7 is performed. After injection of 5 mL normal saline, a catheter (PAJUNK, Geisingen, Germany) is advanced medially the estimated distance to the paravertebral space. After injection of 1% lidocaine 15ml, the block level is tested by pinprick and recorded 15 minutes later. At the end of operation, syringe contained 0.9% saline is connected to paravertebral catheter, a 10ml bolus of 0.9% saline is injected via the paravertebral catheter, followed by an infusion of 0.9% saline at 6 ml/h for postoperative pain management.
Sponsors
Netherlands: Ministry of Health, Welfare and Sports
Huazhong University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-70 yrs * American Society of Anesthesiologists physical statusⅠ-Ⅲ * Undergo right lobe hepatectomy * Informed consent
Exclusion criteria
* A known allergy to the drugs being used * Coagulopathy, on anticoagulants * Analgesics intake, history of substance abuse * Participating in the investigation of another experimental agent * Inability to properly describe postoperative pain to investigators (eg, language barrier, neuropsychiatric disorder)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The cumulative opioid consumption | At 24 postoperative hours |
Secondary
| Measure | Time frame |
|---|---|
| The pain scores determined by the numeric rating scale (NRS, 0-10) | At 1, 4, 8, 16, and 24 hrs after the surgery |
| Incidence of postoperative nausea and vomiting | Up to 24 postoperative hrs |
| Incidence of postoperative respiratory depression | Up to 24 postoperative hrs |
| Intraoperative bleeding | Up to 4 hours |
| Postoperative hospital length of stay | Up to 6 weeks |
Countries
China
Outcome results
None listed