Transversus abdominis plane block versus perioperative intravenous lidocaine
versus patient-controlled intravenous morphine for postoperative pain control
after laparoscopic colorectal surgery: study protocol for a prospective,
randomized, double-blind controlled clinical trial.
Author(s): Dewinter G(1), Van de Velde M, Fieuws S, D'Hoore A, Rex S.
Affiliation(s): Author information:
(1)Department of Anaesthesiology, KU Leuven - University of Leuven, University
Hospitals of Leuven, B-3000 Leuven, Belgium. geertrui.dewinter@uzleuven.be.
Publication date & source: 2014, Trials. , 15:476
BACKGROUND: Despite the laparoscopic approach becoming the standard in colorectal
surgery, postoperative pain management for minimally invasive surgery is still
mainly based on strategies that have been established for open surgical
procedures. Patient-controlled epidural and intravenous analgesia are considered
standard postoperative analgesia regimens in colorectal surgery. Epidural
analgesia provides excellent analgesia, but is increasingly scrutinized in
laparoscopic surgery since postoperative pain after the laparoscopic approach is
significantly reduced. Moreover, epidural analgesia can be associated with
numerous complications. Therefore, epidural analgesia is no longer recommended
for the management of postoperative pain in laparoscopic colorectal surgery.
Likewise, patient-controlled intravenous analgesia is subject to significant side
effects. Given these important limitations of the traditional strategies for
postoperative analgesia, effective and efficient alternatives in patients
undergoing laparoscopic colorectal surgery are needed. Both the transversus
abdominis plane block and systemically administered lidocaine have already been
reported to effectively reduce pain after laparoscopic colorectal surgery. We
hypothesize that the transversus abdominis plane block is superior to
perioperative intravenous lidocaine.
METHODS/DESIGN: One hundred and twenty five patients undergoing laparoscopic
colorectal surgery will be included in this prospective, randomized, double-blind
controlled clinical trial. Patients will be randomly allocated to three different
postoperative strategies: postoperative patient-controlled intravenous analgesia
with morphine (control group, n = 25), a transversus abdominis plane block with
ropivacaine 0.375% at the end of surgery plus postoperative patient-controlled
intravenous analgesia with morphine (TAP group, n = 50), or perioperative
intravenous lidocaine plus postoperative patient-controlled intravenous analgesia
with morphine (LIDO group, n = 50). As the primary outcome parameter, we will
evaluate the opioid consumption during the first 24 postoperative hours.
Secondary endpoints include the Numeric Rating Scale, time to return of
intestinal function, time to mobilization, inflammatory response, incidence of
postoperative nausea and vomiting, length of hospital stay and postoperative
morbidity as assessed with the Clavien-Dindo classification.
DISCUSSION: Recognizing the importance of a multimodal approach for perioperative
pain management, we aim to investigate whether a transversus abdominis plane
block delivers superior pain control in comparison to perioperative intravenous
lidocaine and patient-controlled intravenous analgesia with morphine alone.
TRIAL REGISTRATION: EudraCT Identifier: 2014-001499-73; 31 July 2014.
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