Local Anesthesia Versus Saline Serum in Surgical Incision of Colorectal or Hepatic Surgery
Condition: Postoperative Pain; Surgery; Postoperative Complications
MeSH terms: Pain, Postoperative; Postoperative Complications; Surgical Wound
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to determine whether a continuous infusion of local anesthesia
      with a catheter in the surgical wound reduces patient consumption of opiates by 30% in the
      48-hour postoperative period following surgery for colorectal neoplasm and hepatic surgery
      versus the continuous infusion of physiological serum.
    

Detailed description: 
      Postoperative analgesia in major abdominal surgery is managed with intravenous PCA (patient
      controlled analgesia) with morphine associated to non-steroidal anti-inflammatories drugs
      (NSAD) and paracetamol in the first 48 hours of the postoperative phase. With this multimodal
      approach patients undergoing colorectal surgery have a median pain score on the verbal scale
      (0-10) of 3 (range 0-8) with a mean of morphine consumption of 54 mg (SD 24 mg) and patients
      undergoing hepatic surgery have a median pain score of 2(range 0-7) with a mean of morphine
      consumption of 28 mg (SD 17 mg).

      Although opiates are very potent analgesics they also produce side effects and numerous
      studies have demonstrated a significant reduction in morbidity when patients received lower
      dose of opiates during anesthesia and in postoperative period. Continuous infusion of local
      anesthetics in the surgical wound has been used for pain control in different types of
      surgeries. However, controversial reports has been reported in abdominal surgery.

      We are conducting prospective, randomised and double-blind placebo control trials in two
      surgical models (colo-rectal oncologic surgery and hepatic resection) using continuous
      perfusion of ropivacaine 0.38% in the surgical wound versus saline.

      Anesthetic protocol is the same for all patients.

      Patients undergoing colo-rectal surgery can be operated either in laparotomy or laparoscopic
      technique therefore patients are stratified into four groups once surgical closure has begun:

        -  Group A1 ropivacaine and laparotomy

        -  Group A2 ropivacaine and laparoscopy

        -  Group B1 saline and laparotomy

        -  Group B2 saline and laparoscopy

      In the preanesthesia visit patients who match inclusion criteria are invited to participate
      in the study and they signed the informed consent. When the patient is in the theatre a nurse
      not involved in the management of patients opens a closed envelope which indicates the
      solution to be prepared according to the assigned group.

      The surgeon inserts a multiperforated catheter at the subfascial level of surgical wound ,
      just below the suture of the muscular fascia (between the peritoneum and the muscular fascia)
      and after that surgeons finish the subcutaneous plane and the skin. After the closure a bolus
      of 5 ml (laparoscopy colon surgery)or 10 ml (laparotomy colon and hepatic surgery) of the
      solution is given through the catheter and subsequently an elastomer filled with ropivacaine
      or saline is connected. The catheter is fixed to the skin with steri-strip and sterile
      dressing.

      During the procedure we administer in a protocol basis the NSAD and thirty minutes before the
      end of the surgery we administer morphine. In the postoperative period the patient receives a
      NSAD regime and a PCA morphine treatment.

      The catheter is withdrawn after 48 hours and also the PCA and the analgesic treatment is with
      NSAD.
    

Intervention name(s): ropivacaine; saline solution
Intervention type(s): Drug; Drug
Intervention description(s): Laparotomy of colorectal surgery: 10 ml bolus ropivacaine 0,75% + infusion with elastomeric pump with ropivacaine 0,38% at a 5ml/h.
Laparoscopy of colorectal surgery: 5 ml bolus ropivacaine 0,75% + infusion with elastomeric pump with ropivacaine 0,38% at a 2 ml/h.
Hepatic surgery: 10 ml de ropivacaine 0,45% + infusion with elastomeric pump with ropivacaine 0,23 at a 5ml/h.; Laparotomy of colorectal surgery: 10 ml bolus saline solution 0.9% + infusion with elastomeric pump with saline solution 0.9% at a 5ml/h.
Laparoscopy of colorectal surgery: 10 ml bolus saline solution 0.9% + infusion with elastomeric pump with saline solution 0.9% at a 2 ml/h.
Hepatic surgery: 10 ml de saline solution 0.9% + infusion with elastomeric pump with saline solution 0.9% at a 5ml/h
Other intervention name(s): (wound infusion ropivacaine); wound infusion saline solution
Intervention MeSH terms: Ropivacaine; Pharmaceutical Solutions
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: postoperative pain; wound infusion; local anesthesia