Comparing Intrathecal Morphine and Intraoperative Lidocaine Infusion to Epidural Anesthesia With Postoperative PCA for Patients Undergoing Exploratory Laparotomy
- Conditions
- Enlarged UterusAdnexal MassFibroid UterusCancer Debulking
- Interventions
- Registration Number
- NCT05017246
- Lead Sponsor
- Washington University School of Medicine
- Brief Summary
To determine if opioid consumption postoperatively among patients undergoing non-emergent laparotomy by the gynecologic oncology service who receive intrathecal morphine with intraoperative lidocaine (IML) infusion are lower than patients who have epidural anesthesia with PCA (EPCA).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 174
- Female patients ≥18 years old
- Undergoing non-emergent exploratory laparotomy with the Gynecologic Oncology service
- No clinical or laboratory evidence of end organ failure:
If available:
- Platelets > 100 K/cumm
- Hemoglobin > 8.0 g/dl
- Serum creatinine <1.5 mg/dl
- Creatine clearance (CrCl) ≥30 based on the original Cockcroft-Gault formula adjusted for weight.
- INR <1.3 reference range
- All other lab values obtained as part of general preoperative work-up must be ≤1.5x normal laboratory value.
- Patients not giving consent to participate in the study
- Unable to complete self-report pain questionnaire
- Moderate to severe kidney or liver failure per lab criteria as outlined
- Inability to hold anticoagulant medications for a safe amount of time per current ASRA guidelines
- Contraindication to lumbar puncture or epidural placement, per acute pain management service such as known coagulopathy or history of clotting disorders, history of scoliosis or lumbar fusion, infection at site of entry, or current systemic infection
- Complete bowel obstruction
- Contraindication to intravenous lidocaine
- No known pregnancy and not lactating.
- Currently septic
- Patient currently taking more than 30 MME a day preoperatively (for >30 days)
- BMI >50kg/m2
- Intolerance/contraindication or allergy to receiving non-steroidal anti-inflammatory drugs or acetaminophen or any other medications in the pre-operative order set
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intrathecal morphine with intraoperative lidocaine infusion Lidocaine * Day or surgery: tylenol, gabapentin, celebrex, and preoperative intrathecal morphine one time injection (150mcg) * Intraoperative: dexamethasone and lidocaine infusion 1 mg/kg ideal body weight * Day of surgery postoperative: toradol, ibuprofen, tylenol * Postoperative: ibuprofen, oxycodone, and hydromorphone prn Epidural bupivacaine with hydromorphone patient-controlled anesthesia (EPCA) Bupivacaine * Standard of care at Washington University School of Medicine/Barnes-Jewish Hospital * Day of surgery: preoperative tylenol, gabapentin, celebrex, and epidural dosing per standard protocol. * Intraoperative: dexamethasone and epidural bupivacaine * Day of surgery postoperative: hydromorphone PCA, toradol, ibuprofen, tylenol, epidural bupivacaine * Postoperative: hydromorphone PCA, ibuprofen, oxycodone Intrathecal morphine with intraoperative lidocaine infusion Morphine * Day or surgery: tylenol, gabapentin, celebrex, and preoperative intrathecal morphine one time injection (150mcg) * Intraoperative: dexamethasone and lidocaine infusion 1 mg/kg ideal body weight * Day of surgery postoperative: toradol, ibuprofen, tylenol * Postoperative: ibuprofen, oxycodone, and hydromorphone prn
- Primary Outcome Measures
Name Time Method Morphine milligram equivalent (MME) in the postoperative hospital course Postoperatively while patient is in hospital (estimated to be 4 days)
- Secondary Outcome Measures
Name Time Method Patient satisfaction with pain control Day of hospital discharge (estimated to be day 4) -Patients will be asked on day of discharge if they were satisfied with their pain control during their hospitalization. They will be able to choose from the following: 0=satisfied, 1= somewhat satisfied, 2= neutral, 3=somewhat dissatisfied, 4=dissatisfied).
Rate of deep vein thrombosis (DVT) From day of surgery (day 1) to 6 weeks after surgery Rate of persistent pain At 6 week follow-up -As determined by an NRS pain score ≥ 5
Length of hospital stay Estimated to be 4 days -Length of stay will be determined by the dates of admission as recorded on EPIC (days).
Rate of postoperative hypotension Up to 48 hours after surgery -Postoperative hypotension will be defined as \<90/50 (as previously defined by Huepenbecker, et al.) or a 20% decrease from the preoperative office visit.
Rate of postoperative ileus Postoperatively while patient is in hospital (estimated to be 4 days) -Defined by bilious emesis requiring a change in diet to nothing-per-mouth (NPO) status or nasogastric tube placement (NGT) in the absence of other indications. Patients who had NGT placed prophylactically at the time of surgery were not considered to have an ileus unless an NGT was reinserted or they met the above criteria. Participants will be assigned a value of yes ileus or no ileus. The rate of post op ileus is defined as the observed number of yes ileus in each study arm divided by the total number of subjects in the study arm. Fisher's exact test will be used to compare non-paired nominal data.
Change in pain scores Preoperative, each post-operative day while inpatient, 2 week follow-up, and 6 week follow-up -Pain scores will be determined by the 0-10 numeric rating scale (NRS). 0=no pain and 10=the most pain.
30 day readmission rate Through day 30 Rate of pulmonary thromboembolism (PTE) From day of surgery (day 1) to 6 weeks after surgery
Trial Locations
- Locations (1)
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States