A Comparison Between Continuous and Intermittent Intraabdominal Analgesia Using Local Anaesthetics
Condition: Abdominal Hysterectomy
Study type: Interventional
Phase: Phase 4

Summary: 
      The investigators hypothesis is that patient controlled local anesthetics administered
      intraabdominally are more efficacious compared to continuous infusion in reducing
      postoperative pain and morphine consumption.
    

Detailed description: 
      Open abdominal hysterectomy is a common procedure performed for many benign and malignant
      gynaecological diseases and is associated with moderate to severe pain. Traditional methods
      for postoperative pain management include patient controlled intravenous analgesia (PCA)
      using morphine, epidural analgesia and spinal analgesia with opiates but recently, even local
      aesthetic (LA) has been used intra-abdominally and into the abdominal wall. Although epidural
      analgesia may be considered by some to be gold standard for pain relief following abdominal
      surgery, a recent publication and past experience over several years may question the use of
      invasive techniques for lower abdominal surgery. Thus, there is a trend towards movement from
      central blocks towards other non-invasive methods for pain relief.

      PCA with morphine is now commonly used for management of pain following major surgery and
      compared to central blocks, has advantages in being relatively safe, easy to use and
      associated with a high degree of patient satisfaction. However, the large doses of morphine
      necessary to ensure adequate postoperative analgesia means that side effects such as
      postoperative nausea and vomiting (PONV), tiredness, pruritus, headache and constipation may
      be a major problem in this group of patients. Therefore, alternative techniques to reduce
      morphine requirements are increasingly being used. These include the use of paracetamol,
      non-steroidal anti-inflammatory drugs (NSAID) and recently local anaesthetics (LA). The
      latter have been found to result in morphine sparing by 30 - 40 % and even a reduction in
      postoperative nausea (PON). LA infused intraperitoneally is safe and effective and a recent
      study showed that using 12.5 mg/h levobupivacaine could attain adequate analgesia. Thus,
      efficacy of LA has been established as well as the dose. However, the method of
      administration of LA intraperitoneally remains unclear.

      This study is designed with the primary aim of studying whether morphine consumption can be
      reduced postoperatively using the patient-controlled administration system for
      intraperitoneal LA compared to a continuous infusion, and whether this translates into
      improved recovery parameters or reduced side effects and improved patient satisfaction.
    

Intervention name(s): PCRA (Intermittent injection)
Intervention type(s): Drug
Intervention description(s): Intermittent injection of LA intraabdominally
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Postoperative pain; Anesthetics: Local anesthetics; Surgery: Hysterectomy