Postoperative Pain
Conditions
Brief summary
In early postoperative period, the occurrence of severe pain after open major upper GI surgery is a significant issue. The study is aimed to access the efficiency of rectus sheet block with continuous bupivacaine infusion catheters into retromuscular space in providing an effective pain relief, decreasing opioid consumption and enhancing postoperative recovery.
Detailed description
This prospective randomised case-control experimental study is being conducted in Riga East University Hospital (Latvia). Patients with total or subtotal open gastrectomy were divided into two groups - half patients in the Block group and half patients in the Control group. In the Block group and control group, retromuscular catheters in the m. rectus abdominis sheath is going to be placed before fascia closure. Catheters will be placed under the direct supervision of a surgeon throughout the operation wound on both sides of the incision. After surgery patients in the Block group will receive continuous 0.125% (10-12 mg/h) bupivacaine infusion through rectus sheath catheters for 72 h. Additionaly ketorolac or trimeperidine infusion will be performed if VAS of pains more than 30mm. If pains continue, additional opioids will be performed. Patients in the Control group received 0,9% NaCl solution 72 hours by using the same easy pump system, and ketorolac or trimeperidine injection if necessery Pain intensity will be assessed in both groups using 0-100 mm Visual Analog Scale (VAS) at 24, 48 and 72 hour intervals after surgery at rest and during movement (by asking the patient to bend legs). Postoperative complications, hospital stay, comorbidities, the time taken to start walking after the surgery, bowel movements (time until first stool) were all examined.
Interventions
PROCEDUREBilateral retromuscular rectus sheath block catheters usage for early postoperative analgesia after laparotomic gastrectomy.
After surgery patients in the Block group receives continuous 0.125% (10-12 mg/h) bupivacaine infusion through rectus sheath catheters for 72 h in addition to fentanyl i/v infusion on postoperative day 0, and ketorolac or trimeperidine injection on postoperative day 1-2 if necessery. Patients in the Control group receives NaCl 0,9% infusion and fentanyl i/v infusion on postoperative day 0 and ketorolac or trimeperidine injection on postoperative day 1-2 if necessery Pain intensity is going to be assessed in both groups using 0-100 mm Visual Analog Scale (VAS) at 24, 48 and 72 hour intervals after surgery at rest and during movement (by asking the patient to bend legs). Postoperative complications, hospital stay, comorbidities, the time taken to start walking after the surgery, bowel movements (time until first stool) were all examined.
DEVICECatheter insertion technique by using special tube t
By using special tube, it is possible to locate the catheters in retromuscular space, where they are close to cutaneous nervs
PROCEDUREConnection of catheters bilateraly to easy pump system,
Connection of catheters, which are inserted in to retromuscular space, to ensure continuous receiving of Bupivacaine fluid for analgesia. Easy pump system provides continous receiving of bupivacaine fluid infusion speed - 5ml per hour
DIAGNOSTIC_TESTVAS scale for pain control
By using Visual Analog scale of pains, the pain score is fixed
Sponsors
University of Latvia
Riga East Clinical University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Open Laparotomy and gastrectomy
Exclusion criteria
* acute surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores | 3 days | Patients will be asked to score their pain in recovery and on days 0,1,2,3 post surgery |
| Opioid usage after surgery | 3 days | If the VAS of pains is more than 30mm, after receiving NSAIDs, opioid solution will be performed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peri-operative analgesic use | 4 days | Analgesic use intra-operatively and post-operatively for 3 days. This will include strong opioids, paracetamol, NSAIDs, codeine, ketamine, IV lignocaine, tramadol, clonidine and PCA usage post-operatively. |
| TIme to diet and mobilisation | likely 5 days | Time to first defecation |
| Time to discharge | approximately 7 days | how many days after Surgery |
| Postoperative complications | approximately 14 days | all postoperative complications (Clavien Dindo classification) |
Countries
Latvia
Outcome results
None listed