Ileus
Conditions
Keywords
Thoracic epidural analgesia, bowel function recovery
Brief summary
The investigators try to find whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to iv-PCA and promotes earlier discharge after major upper abdominal surgery.
Detailed description
Postoperative ileus (POI) is a prolonged inhibition of coordinated bowel activity after surgery. Half of patients undergoing major abdominal surgery experience POI making it one of the limiting factors for early recovery. The pathogenesis of POI is multifactorial, and includes neurogenic, inflammatory and pharmacological mechanisms. Thoracic epidural analgesia (TEA) can induce sympathetic block, attenuate inflammatory reaction and limit use of systemic opioids. In addition, sympatholysis induced by TEA can improve microcirculation of bowels and parasympathetic activation can increase gastrointestinal motility. However, studies comparing TEA and iv-PCA on POI are rare in major upper abdominal surgeries. This study, therefore, compares TEA and iv-PCA in terms of bowel function recovery as a primary endpoint in major upper abdominal surgeries. Secondary endpoints are side effects and hospital stay.
Interventions
PROCEDUREthoracic epidural analgesia
In a sitting position, an 18-gauge Tuohy needle is introduced at T6-7 or T7-8 intervertebral space using a paramedian approach. An epidural catheter is advanced 5 cm beyond the tip of the needle and secured with a sterile dressing. For TEA regimen, hydromorphone (8 mcg/ml) was added to 0.15% ropivacaine. TEA setting was bolus/lock out time/basal, 3 ml/15 min/5 ml.
DRUGiv-PCA
iv-PCA setting was fentanyl 20 mcg/ml, bolus/lock out time/basal, 0.5 ml/15 min/0.5 ml.
Sponsors
Samsung Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists' (ASA) physical statusⅠ-Ⅲ
Exclusion criteria
* ASA status of Ⅳ, or more * Body mass index 30 kg.m2-1 or more * Severe renal, hepatic, or neurologic diseases * Opioid or systemic analgesic preoperatively
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| gas out time | from operation to post operative 10 days |
Secondary
| Measure | Time frame |
|---|---|
| voiding time | from operation to post operative 10 days |
| numeric rating scale for pain | from operation to post operative 3 days |
Countries
South Korea
Outcome results
None listed