Acute Pain Clinical Trial
Official title:
Paravertebral Catheter Use for Postoperative Pain Control in Patients After Lung Transplant Surgery: A Prospective Observational Study
This is a prospective observational trial of patient undergoing lung transplantation who have a thoracic paravertebral catheter(s) placed for postoperative pain control. Patients pain scores and opioid use were evaluated for 7 days after placement as well as any complications, opioid adverse events, and length of stay.
Following approval of the University of Minnesota Institutional Review Board, 33 consecutive
adult patients (≥ 18 years of age) were observed from October 2013 to December 2014 who
underwent either single or bilateral lung transplantation and received a continuous
paravertebral block. The paravertebral catheters were placed within 1-2 day postoperatively
in the intensive care unit. If the patient was too hemodynamically unstable or too
critically ill to be placed in lateral decubitus position, the placement of the catheter was
delayed or in some cases not performed (these patients were not included in study) They were
placed via an in plane transverse technique. The ultrasound was placed on the patient's back
at the T8-9 level with probe in transverse orientation. Then a 17-gauge tuohy needle was
advanced lateral to medial in plane until beneath the transverse process upon which a test
dose of 3-5 mL of 1.5% lidocaine with 1:200,000 epinephrine was injected to see adequate
spread. The catheter was then fed 1 centimeter past the tip of the tuohy needle and needle
was withdrawn. All catheters were confirmed to be in correct position with real time local
anesthetic injection and secured with skin glue and occlusive dressing. Each was performed
with the patient in the left lateral decubitus position for the right catheter and right
lateral decubitus position for the left catheter. The paravertebral catheters remained in
place for up to seven days postoperatively in unilateral lung transplants and up to ten days
postoperatively in bilateral lung transplants. During that time an infusion of 0.2%
ropivacaine was infused at a rate of 0.2-0.25 ml/kg/hour through an elastomeric pump (ON Q
Halyard Health).
The outcome measured were minimal and maximum pain scores from the first 7 days post
paravertebral catheter placement (rated on an 11-point numeric rating scale; 0=no pain,
10=worst pain imaginable). The acute pain Nurse Practitioners, bedside nurses, or acute pain
anesthesiology residents collected the pain scores. Additional outcomes of interest included
postsurgical opioid use through postsurgical day 7, and length of hospital stay. Patients
were asked daily if they experienced nausea/vomiting, however, Nursing notes and physician
progress notes were also evaluated if patients experienced any adverse events or nausea and
vomiting. Demographics such as age and weight were recorded in addition to length of surgery
and time spent in the hospital before discharge.
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Observational Model: Cohort, Time Perspective: Prospective
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