Effect of Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Pain After Surgery
- Conditions
- Postoperative Pain
- Interventions
- Registration Number
- NCT05122338
- Lead Sponsor
- Tianjin Medical University General Hospital
- Brief Summary
Purpose:
To explore effects of ultrasound-guided transversus abdominis plane block with compound lidocaine and esketamine on postoperative pain after colorectal cancer surgery.
- Detailed Description
Poor post-surgical pain control is a leading factor that hinders the physical rehabilitation, and causes acute cognitive impairment and chronic pain syndrome. Recently, the multimodal analgesia strategies to minimise opioid related side effects are highly desirable in open surgical procedures. The transversus abdominis plane block is a novel technique involving injection of local anaesthetic between the internal oblique and the transversus abdominis muscles of the abdominal wall. Although ropivacaine is most commonly used for this technique, the analgesic duration remains not dissatisfied. Compared with ropivacaine, compound lidocaine injection has a better and longer analgesic activity since it contains menthol and ethanol with appropriate concentrations. However, whether compound lidocaine injection is efficiency in the transversus abdominis plane block for abdominal surgery lacks investigations. Herein, we will evaluate the efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block with compound lidocaine injection and esketamine for postoperative analgesia in patients undergoing colorectal cancer surgery.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 160
- Subject is scheduled to undergo colorectal cancer surgery under general anesthesia
- Subject's American Society of Anesthesiologists physical status is I-II.
- The subject's parent/legally authorized guardian has given written informed consent to participate.
- Subject has a diagnosis of bronchial asthma, coronary heart disease, severe hypertension, renal failure or liver failure.
- Subject has a diagnosis of Insulin dependent diabetes.
- Subject is allergy and contraindication to local anesthetics or any components of local anesthetics.
- Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre- existing therapy with opioids, intake of any analgesic drug within 48 hours before surgery.
- Subject has any contraindication for the use of patient-controlled analgesia (PCA).
- Subject is pregnant or breast-feeding.
- Subject is obese (body mass index >30kg/m^2).
- Subject is incapacity to comprehend pain assessment and cognitive assessment.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Compound lidocaine and esketamine in transversus abdominis plane block Compound lidocaine Before the induction of anesthesia, 0.4% compound lidocaine and 0.4mg/kg esketamine are used for bilateral transversus abdominis plane block in a volume of 20 mL of each side. Normal saline in transversus abdominis plane block Normal saline Before the induction of anesthesia, normal saline is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side. Compound lidocaine in transversus abdominis plane block Compound lidocaine Before the induction of anesthesia, 0.4% compound lidocaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side. Ropivacaine in transversus abdominis plane block Ropivacaine Before the induction of anesthesia, 0.375% ropivacaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side. Compound lidocaine and esketamine in transversus abdominis plane block Esketamine Before the induction of anesthesia, 0.4% compound lidocaine and 0.4mg/kg esketamine are used for bilateral transversus abdominis plane block in a volume of 20 mL of each side.
- Primary Outcome Measures
Name Time Method Postoperative opioid consumption 48 hours after surgery Each patient was administered analgesics using a PCA (Patient-controlled analgesia) pump containing opioid in normal saline after leaving PACU (Postanesthesia care unit). Opioid cumulative consumption is recorded for 48 hours postoperatively.
- Secondary Outcome Measures
Name Time Method Time of First Postoperative Analgesic Requirement 1 hour after surgery First postoperative pain (NRS≥5) is initially controlled by titration of opioid.
Mean time until passage of flatus 96 hours after surgery Gastrointestinal motility was evaluated by recording mean time until passage of flatus
Diffusion area of local anesthetics after transversus abdominis plane block 30 minutes after transversus abdominis plane block Diffusion area of local anesthetics after transversus abdominis plane block was calculated under ultrasound assistance.
Pain Score (NRS) 48 hours after surgery The pain score at rest or after movement was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10 = greatest imaginable pain.
The level of cytokines in blood By ELISA kits 48 hours after surgery Blood is collected to measure the level of cytokines (such as IL-18, IL-17, IL-23 ) using ELISA kits.
The incidence of Side Effects 48 hours after surgery The number of patients with side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus is recorded for 48 hours postoperatively.
Apfel score The 1 day before the surgery The Apfel score was recorded for evaluating risk for developing postoperative nausea and vomiting (PONV).
Normalized Area of Hyperalgesia Around the Incision 48 hours after surgery The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper'feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament.
Total Dose of First Postoperative Analgesic Requirement 1 hour after surgery First postoperative pain (NRS≥5) is initially controlled by titration of opioid.
The level of chemokines in blood By ELISA kits 48 hours after surgery Blood is collected to measure the level of chemokines (such as CXCL1, CCL7, CCL2) using ELISA kits.