A Prospective, Randomized Analysis of Epidural Anesthesia Using Programmed Intermittent Epidural Boluses Versus Continuous Epidural Infusion in Patients Undergoing Abdominal Surgery.
Overview
- Phase
- Phase 4
- Intervention
- Bupivacaine
- Conditions
- Pain, Acute
- Sponsor
- University of California, San Francisco
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- Total Local Anesthetic Utilized in First 24 Hours
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
Epidurals are an effective means for providing neuraxial anesthesia and analgesia. Prior studies in labor epidurals have demonstrated that a programmed intermittent bolus application of local anesthesia can improve pain control by reducing the amount of local anesthetic required as well as improve patient satisfaction when compared to continuous epidural infusions. The effects of programmed intermittent bolus of epidural local anesthetics compared to continuous epidural infusions in a surgical setting have yet to be elucidated. Our goal is to evaluate the use of programmed intermittent bolus compared to continuous epidural infusion in a surgical patient population. We plan to enroll patients already undergoing abdominal surgeries including colorectal, gynecologic, surgical oncology, urological where epidural anesthesia can be employed. The primary endpoints of the study will be the total local anesthetic consumption and total opioid consumption as surrogate markers for the quality of epidural anesthesia. Secondary endpoints are pain scores and functional measurements, patient satisfaction, and incidence of hypotension.
Detailed Description
See brief summary
Investigators
Eligibility Criteria
Inclusion Criteria
- •American Society of Anesthesia physical classification I - III, scheduled for surgery with anticipated an epidural anesthesia (including but not limited to colorectal, surgical oncology, urology, gynecology) as part of their perioperative treatment
Exclusion Criteria
- •Age younger than 18 years of age, non-English speaking, contraindication for neuraxial anesthesia (such as, but not limited to coagulopathy, infection at site, allergy to local anesthetic), preexisting neurologic deficits, inability to consent due to cognitive dysfunction, patients with pain numeric rating score \> 5 each day for greater than 3 months, daily opioid consumption \> 100 oral morphine equivalents for 14 consecutive days prior to surgery, patient refusal.
Arms & Interventions
Continuous epidural infusion
At our institution, the most commonly utilized form of administration of medication through an epidural (our active comparator/control) is as follows: Combination of 0.0625% bupivacaine with 2mcg/ml of fentanyl infused at a constant rate of 8ml/hr. The patient has the ability to self administer patient controlled epidural analgesia of 2ml of the epidural medication with a lock out period of 15 min. The total maximum volume of epidural medication each hour is 16ml. These settings are managed and controlled by a epidural medication pump. Additional oral and intravenous analgesia medications are available as scheduled and pro re nata.
Intervention: Bupivacaine
Continuous epidural infusion
At our institution, the most commonly utilized form of administration of medication through an epidural (our active comparator/control) is as follows: Combination of 0.0625% bupivacaine with 2mcg/ml of fentanyl infused at a constant rate of 8ml/hr. The patient has the ability to self administer patient controlled epidural analgesia of 2ml of the epidural medication with a lock out period of 15 min. The total maximum volume of epidural medication each hour is 16ml. These settings are managed and controlled by a epidural medication pump. Additional oral and intravenous analgesia medications are available as scheduled and pro re nata.
Intervention: Fentanyl
Programmed intermittent epidural bolus
For the programmed intermittent epidural bolus group: Combination of 0.0625% bupivacaine with 2mcg/ml of fentanyl will be administered as a bolus of 4ml every 30 minutes. The patient has the ability to self administer patient controlled epidural analgesia of 2ml of the epidural medication with a lock out period of 10 min. The total maximum volume of epidural medication each hour is 16ml. These settings are managed and controlled by a epidural medication pump. Additional oral and intravenous analgesia medications are available as scheduled and pro re nata.
Intervention: Bupivacaine
Programmed intermittent epidural bolus
For the programmed intermittent epidural bolus group: Combination of 0.0625% bupivacaine with 2mcg/ml of fentanyl will be administered as a bolus of 4ml every 30 minutes. The patient has the ability to self administer patient controlled epidural analgesia of 2ml of the epidural medication with a lock out period of 10 min. The total maximum volume of epidural medication each hour is 16ml. These settings are managed and controlled by a epidural medication pump. Additional oral and intravenous analgesia medications are available as scheduled and pro re nata.
Intervention: Fentanyl
Outcomes
Primary Outcomes
Total Local Anesthetic Utilized in First 24 Hours
Time Frame: In first 24 hours
Total local anesthetic consumed while epidural in place, recorded on infusion pump
Secondary Outcomes
- Total Opioid Consumed(While epidural in place (up to 72 hours post operatively))
- Worst Reported 24 Hour Pain(While epidural in place (up to 72 hours postoperatively))
- Patient Satisfaction Score(While epidural in place (up to 72 hours postoperatively))
- Average Pain Severity(While epidural in place (up to 72 hours postoperatively))
- Incidence of Hypotension(While epidural in place (24 hours postoperatively))
- Average Pain Interference(While epidural in place (up to 72 hours postoperatively))