A Trial Comparing Transversus Abdominis Plane Catheter Versus Epidural After Esophagectomy
| Status: | Recruiting |
|---|---|
| Conditions: | Cancer, Cancer, Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal, Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/20/2018 |
| Start Date: | January 1, 2018 |
| End Date: | June 2021 |
| Contact: | Brian E Louie, MD |
| Email: | brian.louie@swedish.org |
| Phone: | 206-215-6800 |
A Randomized Controlled Trial Comparing Transversus Abdominis Plane Catheter Versus Epidural After Esophagectomy
A randomized trial comparing perioperative outcomes between bilateral transversus abdominis
plane TAP catheters with patient controlled analgesia (PCA) to epidural for esophagectomy
patients with a VATS chest approach. Further objectives are to determine pain requirements
between multiple modalities of pain control and compare the subsequent sequelae of narcotic
use and blood pressure control and to compare complications such as anastomotic leak, atrial
fibrillation and perioperative morbidity and mortality between the two groups.
plane TAP catheters with patient controlled analgesia (PCA) to epidural for esophagectomy
patients with a VATS chest approach. Further objectives are to determine pain requirements
between multiple modalities of pain control and compare the subsequent sequelae of narcotic
use and blood pressure control and to compare complications such as anastomotic leak, atrial
fibrillation and perioperative morbidity and mortality between the two groups.
Epidural analgesia is considered the 'gold standard' for post-operative analgesia following
open esophagectomy. Epidurals have been shown to reduce post-operative pulmonary morbidity
and mortality. However, epidurals are often associated with sympathetic blockade that creates
hypotension and could therefore adversely affect the conduit. Pain management techniques that
use peripheral nerve blockade are becoming more prevalent, reducing the need for an epidural.
Transversus abdominis plane (TAP) catheters have been used in colorectal and abdominal
surgery showing equivocal pain scores to epidurals. With the minimally invasive chest
approach, the analgesia coverage focuses on the abdominal incision where both epidurals and
TAPs are considered standard of care.
The investigators have completed a retrospective study in preparation for a randomized
control trial. The investigators previous retrospective study found that TAP blocks/catheters
are a reasonable alternative to epidurals, providing adequate pain coverage for abdominal
incisions. The study found no statistical difference in pain scores between the two groups.
The TAP group had a lower prevalence of hypotension and lower crystalloid resuscitation
needs. Pulmonary complications were similar between the two groups. This retrospective review
showed that TAP blocks are a reasonable alternative to epidurals and may reduce episodes of
hypotension. The investigators aim is to now expand this study to a randomized control trial.
open esophagectomy. Epidurals have been shown to reduce post-operative pulmonary morbidity
and mortality. However, epidurals are often associated with sympathetic blockade that creates
hypotension and could therefore adversely affect the conduit. Pain management techniques that
use peripheral nerve blockade are becoming more prevalent, reducing the need for an epidural.
Transversus abdominis plane (TAP) catheters have been used in colorectal and abdominal
surgery showing equivocal pain scores to epidurals. With the minimally invasive chest
approach, the analgesia coverage focuses on the abdominal incision where both epidurals and
TAPs are considered standard of care.
The investigators have completed a retrospective study in preparation for a randomized
control trial. The investigators previous retrospective study found that TAP blocks/catheters
are a reasonable alternative to epidurals, providing adequate pain coverage for abdominal
incisions. The study found no statistical difference in pain scores between the two groups.
The TAP group had a lower prevalence of hypotension and lower crystalloid resuscitation
needs. Pulmonary complications were similar between the two groups. This retrospective review
showed that TAP blocks are a reasonable alternative to epidurals and may reduce episodes of
hypotension. The investigators aim is to now expand this study to a randomized control trial.
Inclusion Criteria:
- All adult individuals who undergo an esophagectomy with a minimally invasive approach
of the chest at Swedish Medical Center-First Hill. These approaches include:
- 3 hole with R video-assisted thoracoscopic surgery (VATS)
- Ivor Lewis R VATS
- Transhiatal
Exclusion Criteria:
- Age <18
- Unable to consent
- Additional surgical procedures planned
- Patient with chronic pain on a daily regimen of narcotics
- Patients who remain intubated greater than 24 hours post operatively
- Non-English speaking
We found this trial at
1
site
Seattle, Washington 98104
Principal Investigator: Brian E Louie, MD
Phone: 206-215-6800
Click here to add this to my saved trials
