Comparing Intrathecal Morphine and Intraoperative Lidocaine Infusion to Epidural Anesthesia With Postoperative PCA for Patients Undergoing Exploratory Laparotomy

• Status: Not yet recruiting
• Trial end date: 2022-12-15
• Target enrollment: 0
• Participant gender: Female

Summary

To determine if opioid consumption postoperatively among patients undergoing non-emergent laparotomy by the gynecologic oncology service who receive intrathecal morphine with intraoperative lidocaine (IML) infusion are lower than patients who have epidural anesthesia with PCA (EPCA).

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Washington University School of Medicine
• Collaborator: The Foundation for Barnes-Jewish Hospital
• Treatments: Bupivacaine; Lidocaine; Morphine

Criteria

Inclusion Criteria:

• Female patients ≥18 years old

• Undergoing non-emergent exploratory laparotomy with the Gynecologic Oncology service

• No clinical or laboratory evidence of end organ failure:

If available:

• Platelets > 100

• Hemoglobin > 8.0

• Serum creatinine <1.5

• INR <1.3

• All other lab values obtained as part of general preoperative work-up must be ≤1.5x normal laboratory value.

Exclusion Criteria:

• Patients not giving consent to participate in the study

• Unable to complete self-report pain questionnaire

• Moderate to severe kidney or liver failure per lab criteria as outlined

• Current treatment with anticoagulant drugs or inability to hold anticoagulant medications for a safe amount of time per current ASRA guidelines

• Contraindication to lumbar puncture or epidural placement, per acute pain management service such as known coagulopathy or history of clotting disorders, history of scoliosis or lumbar fusion, infection at site of entry, or current systemic infection

• Complete bowel obstruction

• Contraindication to intravenous lidocaine

• No known pregnancy and not lactating.

• Currently septic

• Patient currently taking more than 30 MME a day preoperatively (for >30 days)

• BMI >50kg/m2

• Intolerance or contraindication to receiving non-steroidal anti-inflammatory drugs or acetaminophen