Comparing the Outcome of Two Intraoperative Analgesia Techniques After Hepato-pancreato-biliary Surgery
Status:
Unknown status
Trial end date:
2012-01-01
Target enrollment:
Participant gender:
Summary
Inadequate pain control after abdominal procedures may lead to adverse postoperative outcome.
Epidural analgesia is currently an accepted technique in abdominal surgery, but its use has
been limited in liver resections by postoperative coagulation disturbances and the possible
increased risk of bleeding complications, including spinal hematoma. A range of alternative
analgesic techniques can be used for major liver or pancreatic resections, including
intrathecal morphine (single shot) administered immediately before surgery, and continuous
administration of intravenous (IV) short-acting opioids, such as remifentanil, plus a single
bolus of IV morphine. Postoperatively analgesia may be obtained by patient-controlled
morphine analgesia (IV PCA). Both protocols have been demonstrated to provide satisfactory
postoperative pain relief, and each has its unique advantages. However, to this end there is
no data in the literature to show benefit from one regimen over the other. We therefore wish
to determine whether there is a difference in analgesic efficacy between the two techniques,
as optimizing perioperative pain relief in this rapidly expanding surgical field is of utmost
importance. Our hypothesis is that continuous intraoperative IV analgesia with remifentanil
followed by IV PCA morphine is not inferior to intrathecal morphine with respect to analgesia
and ambulation outcome, and may provide an alternative, non-invasive intraoperative analgesic
technique.