Autonomic Neural Field Block for Visceral Pain Control in Minimally Invasive Left-Sided Colorectal Resections
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 400
研究概览
简要总结
Effective postoperative pain control is a core component of enhanced recovery after surgery (ERAS) pathways in colorectal surgery; however, postoperative pain following minimally invasive left-sided colectomy remains a persistent clinical challenge. Standard multimodal analgesic strategies primarily target somatic pain pathways and may inadequately address visceral postoperative pain, which is mediated through autonomic afferent neural pathways. Residual visceral pain is associated with increased opioid consumption, postoperative nausea and vomiting, delayed recovery, and prolonged length of stay.
This prospective, multicenter observational registry evaluates the feasibility and real-world outcomes of an intraoperative autonomic neural field block targeting the superior hypogastric and inferior mesenteric plexuses during minimally invasive left-sided colectomy. The technique is performed under direct visualization as an adjunct to standard ERAS-based analgesic care. The primary outcome is postoperative opioid consumption within the first 24 hours after surgery. Secondary outcomes include opioid use through 48 hours, postoperative nausea and vomiting, antiemetic use, pain scores, length of stay, and readiness for discharge. Data from this registry will inform future comparative studies and help define the role of autonomic neural modulation in perioperative pain management for colorectal surgery.
详细描述
Background and Rationale
Effective postoperative pain control is a cornerstone of enhanced recovery after surgery (ERAS) pathways in colorectal surgery. Adequate analgesia facilitates early mobilization, pulmonary hygiene, gastrointestinal recovery, and timely hospital discharge. Despite widespread adoption of ERAS protocols and multimodal, opioid-sparing analgesic strategies, postoperative pain following left-sided colectomy remains a clinically relevant and persistent challenge. A substantial proportion of patients continue to experience moderate to severe pain in the early postoperative period, which may contribute to increased opioid consumption, postoperative nausea and vomiting (PONV), delayed functional recovery, and prolonged length of stay.
Current perioperative analgesic approaches in colorectal surgery predominantly address somatic pain pathways. These strategies include non-opioid analgesics, opioid-based regimens, local anesthetic infiltration, neuraxial techniques, and transversus abdominis plane (TAP) blocks. While effective in reducing abdominal wall and incisional pain, these modalities do not specifically target visceral postoperative pain, which is mediated through autonomic afferent neural pathways. Visceral pain arises from bowel distension, traction, ischemia, and inflammatory processes affecting the colon and mesentery and is transmitted primarily via sympathetic and parasympathetic fibers. This component of postoperative pain is qualitatively distinct, often diffuse and poorly localized, and frequently associated with nausea, ileus, and other autonomic symptoms.
Neuraxial techniques may provide effective visceral analgesia but are invasive, resource-intensive, and associated with potential adverse effects such as hypotension and urinary retention. As a result, many contemporary ERAS pathways have moved away from routine neuraxial analgesia, creating an unmet need for effective, targeted visceral pain control that is compatible with minimally invasive surgical workflows and ERAS principles.
Targeted modulation of autonomic neural pathways involved in visceral afferent transmission represents a potential strategy to address this gap. The superior hypogastric plexus and inferior mesenteric plexus play central roles in transmitting visceral sensory input from the left colon and rectum and are anatomically consistent structures routinely encountered during left-sided colorectal resection. Intraoperative autonomic neural field block targeting these plexuses may offer a mechanistically distinct approach to perioperative analgesia that complements existing somatic-focused techniques.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age ≥ 18 years.
- •Scheduled for elective minimally invasive (laparoscopic or robotic) left-sided colonic or rectal resection with primary anastomosis constructed above the peritoneal reflection (e.g., sigmoid colectomy, left colectomy, anterior resection/rectosigmoid resection with intraperitoneal anastomosis).
- •Planned intraoperative administration of autonomic neural field block targeting the superior hypogastric plexus and/or inferior mesenteric plexus, performed under direct visualization, as part of routine operative workflow.
- •Managed perioperatively under an institutional standard analgesic pathway (e.g., ERAS or equivalent), with postoperative opioid administration recorded in the medical record.
- •Ability to provide informed consent
排除标准
- •Emergency/urgent colorectal surgery (e.g., perforation, uncontrolled bleeding, toxic megacolon, obstructing cancer requiring urgent operation).
- •Planned open left-sided colectomy/rectal resection (minimally invasive approach not intended).
- •Procedures in which no primary anastomosis is created (e.g., Hartmann's procedure, end colostomy, permanent diversion without anastomosis).
- •Planned low pelvic/extra-peritoneal anastomosis (e.g., low anterior resection with anastomosis at or below the peritoneal reflection) or planned handsewn coloanal anastomosis.
- •Known allergy or contraindication to the local anesthetic agents used for the block (or inability to receive local anesthetic for clinical reasons).
- •Inability to reliably capture outcome data for the primary endpoint (e.g., anticipated transfer to another facility within 24 hours post-op, incomplete medication administration records).
- •Pregnancy
- •Prisoners or other protected populations where participation is restricted
- •Chronic opioid therapy at baseline defined as daily opioid use for > 30 days preoperatively, or baseline opioid dose > 30 MME/day
- •Planned use of neuraxial analgesia (epidural/spinal) intended for postoperative analgesia
研究者
Antonio Caycedo, MD
Chief of Colorectal Surgery
Orlando Health, Inc.