Pain, Thoracotomy
Conditions
Brief summary
Objective: Epidural analgesia is the gold standard for post-thoracotomy pain relief but is contraindicated in certain patients. An alternative is continuous wound catheter analgesia. We will investigate whether ropivacaine, administered through a wound catheter placed by the surgeon, will reduce postoperative pain. Methods: In a randomized double-blind study, adult patients with a wound catheter placed by the thoracic surgeon after thoracotomy will be randomly assigned to receive through this catheter, either a 0.1 mL/kg bolus of 0.75% ropivacaine, followed by a continuous infusion of 0.2% ropivacaine at 10 mL/h for 48 h, or saline at the same scheme of administration. Patients will also benefit from patient-controlled analgesia with intravenous morphine (bolus 1 mg, lockout time 7 min), paracetamol, and nefopam. The primary endpoint will be total morphine consumption. Secondary endpoints will be pain intensity on a visual analog scale at rest and on coughing and side effects during the first 48 postoperative hours. Surgeons, anesthesiologists, and all the nurses and caring staff involved in this study will be blinded. Solutions of saline and ropivacaine will be prepared identically by the central pharmacy, without any possible identification of the product.
Interventions
DRUGropivacaine 0.75% - device : wound catheter Silver™ 19 cm and Easypump™ 400 mL (BBraun)
The group ropivacaine, an initial bolus of 0.75% ropivacaine at a volume of 0.1 ml / kg is first administered to the patient directly on the catheter.
DRUGPlacebo
In the placebo group, an initial bolus of saline 9 ‰ to a volume of 0.1 ml / kg will first be administered to the patient directly to the catheter. The patient will then continuous administration of saline 9 ‰ during the first 48 postoperative hours, using a diffuser extensible elastomeric ™ Easypump a volume of 400 mL to 460 mL filled of this solution, a flow rate of 9.53 ml / hour.
DRUGropivacaine 0.2% - device : wound catheter Silver™ 19 cm and Easypump™ 400 mL (BBraun)
The patient will then ongoing administration of ropivacaine 0.2% during the first 48 postoperative hours, using a diffuser extensible elastomeric ™ Easypump a volume of 400 mL to 460 mL filled (B Braun) of this solution, a flow rate of 9.53 ml / hour
Sponsors
University Hospital, Strasbourg, France
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Patients scheduled for thoracotomy who presented with contraindications to TEA. Contraindications to TEA are : * Patient's refusal after informations about advantages and risks of the technique * Anti platelets treatment that can't be discontinued * Anticoagulants at a curative dosage * haemostasis and/or coagulation disorders: thrombopenia \< 100.000/mm3, ACT \> 1,5 / control, PTT \< 75% * Systemic or local infection of the puncture point * 2 and 3 grade atrio-ventricular heart block without pacing * Severe aortic valve stenosis * Kyphoscoliosis * certain neurological disorders
Exclusion criteria
* Patient's refusal to participate in the study * Psychiatric disorder (impossibility to collect the informed consent) * Patient under juridical protection * On going an other study * Pregnancy, breastfeeding * Non balanced epilepsy * 3 grade auriculo-ventricular heart block without pacing * Severe hepatocellular insufficiency * Anti arrhythmic treatment : class III of the Vaughan William's classification * Skin infection of the puncture point * Allergy to aminoamides local anaesthetic * Surgical difficulties to insert paravertebral catheter
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total intravenous morphine consumption (mg) | the first 48 hours after surgery |
Countries
France
Outcome results
None listed