RCT - Epidural vs. wound catheter following liver resection
Research type
Research Study
Full title
An RCT comparing Epidural versus continuous Local Anaesthetic infiltration with wound catheters, TAP Block and PCA after open liver resection
IRAS ID
143673
Contact name
Ernest Hidalgo
Contact email
Sponsor organisation
Leeds Teaching Hospitals NHS Trust
Research summary
Good postoperative pain control after any major surgery allows early mobilization, minimises post-operative complications and reduces patient distress. Multiple different methods of delivering analgesia have been described. However, the gold standard in abdominal surgery is currently considered to be epidural analgesia (continuous infiltration of local anaesthesia into the epidural space in the spine to block pain signals from the spinal nerves)
Although epidural analgesia has been shown to provide superior analgesia when compared with patient controlled analgesia (PCA), it can cause significant side effects such as lowering blood pressure and causing haematomas (blood clots) or abscesses (collection of pus) in the epidural space. In addition, there is a 20-30% failure rate.
PCA is a simple to use method of IV (injected into a vein) analgesia that is already commonly used for postoperative pain. One method aimed at reducing the need for IV opiates is the placement of indwelling wound catheters (plastic tubes inserted into the tissues near the wound) that continually infuse local anaesthetic around the wound to block abdominal wall nerves. Another technique that has been used successfully in multiple surgical specialities is the TAP block (i.e. infiltration of local anaesthetic into the transversus abdominis plane where nerves supplying the anterior abdominal wall run). Both techniques have been shown to be effective after abdominal surgery and liver resection in several studies and reduce PCA use.
This study aims to compare postoperative pain control between patients with epidural analgesia versus the combination of continuous infiltration of local anaesthetic with wound catheters, TAP block and IV PCA with opiate analgesia following open liver resection.
We expect that pain control will be similar between the two groups but that the utilization of wound catheters will confer benefit due to the lack of systemic side effects associated with epidural analgesia.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
14/YH/1122
Date of REC Opinion
2 Sep 2014
REC opinion
Unfavourable Opinion