Paul Jack Karanicolas1,2, Sean Cleary3,4, Paul McHardy5, Alex Kiss2, Jason Sawyer5, Ramy Behman1, Salima Ladak6, Stuart A McCluskey7, Coimbatore Srinivas7, Joel Katz6,7, Natalie Coburn1,2, Calvin Law1,2, Alice C Wei3, Paul Greig3, Julie Hallet1, Hance Clarke6,7. 1. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. 2. Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario. 3. Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario. 4. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, NY. 5. Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. 6. Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario. 7. Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Ontario.
Abstract
OBJECTIVE:Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective of this trial was to assess the efficacy of a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter analgesia compared with IV PCA. METHODS: This was a blinded, randomized, controlled parallel-arm trial conducted at 2 high-volume centers. Patients undergoing liver resection through a subcostal incision were enrolled. Using a standardized technique, 2 catheters were placed after resection: one in the plane between internal oblique and transversus abdominis and the other in the posterior rectus sheath. Patients were randomized to receive ropivacaine 0.2% (ROP) or saline (NS) through both catheters for 72 hours. All patients received IV PCA with hydromorphone as part of a multimodality analgesia program. Primary outcome was opioid use over the first 48 hours. RESULTS:One hundred fifty-three patients were included in the analysis (71 ROP, 82 NS). Patients receiving ROP used significantly less opioid than patients with NS at 48 hours (median 39.6 mg morphine-equivalent vs 49.2 mg, P = 0.033) and at 72 hours (median 50.0 vs 66.4 mg, P = 0.046). Pain scores at rest and with coughing were significantly lower at all time points in patients who received ROP (P = 0.002). Median length of hospital stay was 5 days in patients receiving ROP and 6 days in patients who received NS (P = 0.035). There was no difference between groups in complications [ROP 20 (28.2%) vs NS 26 (31.7%), P = 0.63]. CONCLUSION:MOTAP catheter analgesia reduces opioid requirements, pain, and length of hospital stay compared with IV PCA following open liver resection with subcostal incisions.
RCT Entities:
OBJECTIVE: Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective of this trial was to assess the efficacy of a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter analgesia compared with IV PCA. METHODS: This was a blinded, randomized, controlled parallel-arm trial conducted at 2 high-volume centers. Patients undergoing liver resection through a subcostal incision were enrolled. Using a standardized technique, 2 catheters were placed after resection: one in the plane between internal oblique and transversus abdominis and the other in the posterior rectus sheath. Patients were randomized to receive ropivacaine 0.2% (ROP) or saline (NS) through both catheters for 72 hours. All patients received IV PCA with hydromorphone as part of a multimodality analgesia program. Primary outcome was opioid use over the first 48 hours. RESULTS: One hundred fifty-three patients were included in the analysis (71 ROP, 82 NS). Patients receiving ROP used significantly less opioid than patients with NS at 48 hours (median 39.6 mg morphine-equivalent vs 49.2 mg, P = 0.033) and at 72 hours (median 50.0 vs 66.4 mg, P = 0.046). Pain scores at rest and with coughing were significantly lower at all time points in patients who received ROP (P = 0.002). Median length of hospital stay was 5 days in patients receiving ROP and 6 days in patients who received NS (P = 0.035). There was no difference between groups in complications [ROP 20 (28.2%) vs NS 26 (31.7%), P = 0.63]. CONCLUSION: MOTAP catheter analgesia reduces opioid requirements, pain, and length of hospital stay compared with IV PCA following open liver resection with subcostal incisions.
Authors: Grzegorz Niewiński; Wojciech Figiel; Michał Grąt; Marta Dec; Marcin Morawski; Waldemar Patkowski; Krzysztof Zieniewicz Journal: World J Surg Date: 2020-07 Impact factor: 3.352