Opioid Consumption
Conditions
Brief summary
General anesthesia combined subcostal transversus abdominis plane (TAP)or rectus sheath block (RSB)can significantly reduce the use of opiates in minimally invasive surgery.However, similar reduction was not observed in open abdominal surgery during perioperative period.Therefore, the investigators should try to improve the blocking methods to reduce the side effects of a large number of opiates. Based on the range and its analgesic effect of various nerve block is obviously related to the injection site of local anesthetics, this randomized controlled study hypothesized that modified RSB under the guidance of surgical incision may be more effective in inhibiting the harmful stimulation of surgery.
Detailed description
For abdominal cancer surgery with midline incision, subcostal transversus abdominis plane or rectus sheath block combined with general anesthesia was more effective in reducing pain scores and opioid consumption compared with general anesthesia alone. However, there was no statistically significant difference in supplementary fentanyl during operation. Besides adequate pain relief around incisions, blunting visceral traction response has also an important role in hemodynamic stability.With the evidences for a potential mechanism for the antinociceptive effects of propofol on visceral nociception and dexmedetomidine combined with oxycodone can provide good visceral analgesia, the investigators supposed that visceral nociception was well suppressed by adequate antinociceptive drugs. The propofol combination with dexmedetomidine may had significant effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate.
Interventions
PROCEDURESubcostal TAP
Subcostal transversus abdominis plane block
PROCEDUREModified RSB
Rectus Sheath Block under the guidance of surgical incision
OTHERGeneral anesthesia
Traditional general anesthesia management
Sponsors
The First Affiliated Hospital of Anhui Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18-85 years * Anesthesiologists (ASA) risk classification I to IV * Scheduled to undergo midline incision of upper abdomen (From xiphoid to navel )
Exclusion criteria
* Patient refusal * Any contraindications to regional techniques (allergy to local anesthetics, infection around the site of the block, and coagulation disorder) * History of analgesics dependence * Any difficulty with communication * Allergy to the study drugs * Heat rate \< 50 beats/minutes or II-III Atrioventricular block * Previous open surgery * Previous definite history of malignant tumor * Who had an estimated intraoperative blood loss of more than 500 mL
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opiate consumption | From the beginning to the end of anesthesia,up to 6 hours. | Remifentanil consumption |
| Tumor recurrence rate | 1-year after surgery | Tumor recurrence rate after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time for first to press pump | Up to 2 days after surgery | Time for first to press pump |
| Time of anal exsufflation | Up to 7 days after surgery | Time for first anal exsufflation |
| Delirium | Up to 7 days after surgery | Incidence of postoperative delirium |
| The occurrence of nausea and vomiting | Up to 7 days after surgery | Incidence of nausea and vomiting |
| The occurrence of cardiovascular or cerebrovascular events | From the end of surgery to the time the patients discharge, up to 1 month. | Incidence of cardiovascular or cerebrovascular adverse events |
| Length of hospital stay | From the end of surgery to the time the patients discharge, up to 1 month. | Length of hospital stay |
| Opiate consumption | From the end of anesthesia to 48 hours after surgery, up to 2 days. | Sufentanil consumption |
| Concentration of norepinephrine | Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity. | Concentration of norepinephrine during surgery |
| Concentration of epinephrine | Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity. | Concentration of epinephrine during surgery |
| Concentration of cortisol | Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity. | Concentration of cortisol during surgery |
| Concentration of tumor necrosis factor-α | Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity. | Concentration of tumor necrosis factor-α during surgery |
| Concentration of interleukin-6 | Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity. | Concentration of interleukin-6 during surgery |
| Mortality | 30-day after surgery | Mortality after surgery |
| Pain scores | 2 hours after surgery | 1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs. |
Countries
China
Outcome results
None listed