Effects of Continuous Bilateral QL Analgesia After Open Abdominal Surgery
| Status: | Recruiting |
|---|---|
| Conditions: | Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/9/2018 |
| Start Date: | March 2016 |
| End Date: | February 2020 |
| Contact: | Wael Ali Sakr Esa, M.D. |
| Email: | ALISAKW@ccf.org |
| Phone: | 216-445-4277 |
The Effects of Continuous Bilateral Quadratus Lumborum Analgesia on Pain, Opioid Consumption, and Opioid-related Complications After Open Abdominal Surgery: A Randomized Controlled Trial
Eligible patients will be randomized 1:1 without stratification to bilateral continuous QL
catheters with local anesthetic continuous infusion (QL block + IV patient-controlled
analgesia group) or normal saline continuous infusion (IV patient-controlled analgesia
group).
In the postanesthesia care unit (PACU), patients will be given intravenous boluses of
hydromorphone or fentanyl as needed. Following immediate recovery from anesthesia, patients
will be provided with a hydromorphone IV patient-controlled analgesia pump with standard
initial settings and an option of clinician dose for breakthrough pain. IV patient-controlled
hydromorphone pump settings will be titrated to comfort level (pain score<4) by blinded
clinicians.
Each of the catheters will be connected to patient controlled infusion pump running at a
basal rate of 6mL/hour of 0.1% Bupivacaine or normal saline with on-demand bolus of 5 mL
every 60 minutes to be started in the operating room before the surgical incision.
Opioid consumption first 72 hours or until discharge, whichever comes first will be recorded.
Pain scores during first 72 hours or until discharge, whichever comes first will be recorded
with a verbal rating scale and obtained from the patient's electronic medical records.
The morning of post operative day 1 and post operative day 3 the ORSDS and QOR surveys will
be completed.
Morning of the day of discharge, the overall patient satisfaction with pain management survey
will be completed.
catheters with local anesthetic continuous infusion (QL block + IV patient-controlled
analgesia group) or normal saline continuous infusion (IV patient-controlled analgesia
group).
In the postanesthesia care unit (PACU), patients will be given intravenous boluses of
hydromorphone or fentanyl as needed. Following immediate recovery from anesthesia, patients
will be provided with a hydromorphone IV patient-controlled analgesia pump with standard
initial settings and an option of clinician dose for breakthrough pain. IV patient-controlled
hydromorphone pump settings will be titrated to comfort level (pain score<4) by blinded
clinicians.
Each of the catheters will be connected to patient controlled infusion pump running at a
basal rate of 6mL/hour of 0.1% Bupivacaine or normal saline with on-demand bolus of 5 mL
every 60 minutes to be started in the operating room before the surgical incision.
Opioid consumption first 72 hours or until discharge, whichever comes first will be recorded.
Pain scores during first 72 hours or until discharge, whichever comes first will be recorded
with a verbal rating scale and obtained from the patient's electronic medical records.
The morning of post operative day 1 and post operative day 3 the ORSDS and QOR surveys will
be completed.
Morning of the day of discharge, the overall patient satisfaction with pain management survey
will be completed.
Inclusion Criteria:
- Adults scheduled for elective colorectal surgery with a midline incision;
- American Society of Anesthesiologists (ASA) physical status 1-3.
Exclusion Criteria:
- Contraindication or intolerance to opioids and/or local anesthetics;
- Inability to use IV PCA system;
- History of chronic pain defined as use of opioids for more than 30 consecutive days
within the 3 preoperative months at the dose equal or greater than equivalent of 15 mg
of morphine and/or abdominal pain for more than 6 months, present most days of the
weeks;
- History of neurological illness and/or neuropathy - Peripheral neuropathy, paralysis;
- Pregnancy and/or breastfeeding;
- Chronic renal failure, defined by estimated GFR <60 ml/min;
- Chronic liver failure, defined by cirrhosis, portal hypertension, or history of
variceal bleeding.
- BMI > 35
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