Continuous Wound Catheter Analgesia Associated With Intravenous Morphine PCA After Thoracotomy

Pain Clinical Trial

Official title:

Postoperative Analgesia After Thoracotomy Without Thoracic Epidural Analgesia: Continuous Wound Catheter Analgesia Associated With Intravenous Morphine Patient-Controlled-Analgesia (PCA)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01698203
• Other study ID #: 5277
• Status: Completed
• Phase: Phase 4
• Start date: October 14, 2012
• Est. completion date: October 11, 2018

Study information

• Verified date: October 2020
• Source: University Hospital, Strasbourg, France
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Objective: Epidural analgesia is the gold standard for post-thoracotomy pain relief but is contraindicated in certain patients. An alternative is continuous wound catheter analgesia. We will investigate whether ropivacaine, administered through a wound catheter placed by the surgeon, will reduce postoperative pain. Methods: In a randomized double-blind study, adult patients with a wound catheter placed by the thoracic surgeon after thoracotomy will be randomly assigned to receive through this catheter, either a 0.1 mL/kg bolus of 0.75% ropivacaine, followed by a continuous infusion of 0.2% ropivacaine at 10 mL/h for 48 h, or saline at the same scheme of administration. Patients will also benefit from patient-controlled analgesia with intravenous morphine (bolus 1 mg, lockout time 7 min), paracetamol, and nefopam. The primary endpoint will be total morphine consumption. Secondary endpoints will be pain intensity on a visual analog scale at rest and on coughing and side effects during the first 48 postoperative hours. Surgeons, anesthesiologists, and all the nurses and caring staff involved in this study will be blinded. Solutions of saline and ropivacaine will be prepared identically by the central pharmacy, without any possible identification of the product.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 92
• Est. completion date: October 11, 2018
• Est. primary completion date: October 14, 2012
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

Patients scheduled for thoracotomy who presented with contraindications to TEA.

Contraindications to TEA are :

• Patient's refusal after informations about advantages and risks of the technique

• Anti platelets treatment that can't be discontinued

• Anticoagulants at a curative dosage

• haemostasis and/or coagulation disorders: thrombopenia < 100.000/mm3, ACT > 1,5 / control, PTT < 75%

• Systemic or local infection of the puncture point

• 2 and 3 grade atrio-ventricular heart block without pacing

• Severe aortic valve stenosis

• Kyphoscoliosis

• certain neurological disorders

Exclusion Criteria:

• Patient's refusal to participate in the study

• Psychiatric disorder (impossibility to collect the informed consent)

• Patient under juridical protection

• On going an other study

• Pregnancy, breastfeeding

• Non balanced epilepsy

• 3 grade auriculo-ventricular heart block without pacing

• Severe hepatocellular insufficiency

• Anti arrhythmic treatment : class III of the Vaughan William's classification

• Skin infection of the puncture point

• Allergy to aminoamides local anaesthetic

• Surgical difficulties to insert paravertebral catheter

Related Conditions & MeSH terms

• Pain
• Thoracotomy

Intervention

Drug:
• ropivacaine 0.75% - device : wound catheter Silver™ 19 cm and Easypump™ 400 mL (BBraun)
The group ropivacaine, an initial bolus of 0.75% ropivacaine at a volume of 0.1 ml / kg is first administered to the patient directly on the catheter.
• Placebo
In the placebo group, an initial bolus of saline 9 ‰ to a volume of 0.1 ml / kg will first be administered to the patient directly to the catheter. The patient will then continuous administration of saline 9 ‰ during the first 48 postoperative hours, using a diffuser extensible elastomeric ™ Easypump a volume of 400 mL to 460 mL filled of this solution, a flow rate of 9.53 ml / hour.
• ropivacaine 0.2% - device : wound catheter Silver™ 19 cm and Easypump™ 400 mL (BBraun)
The patient will then ongoing administration of ropivacaine 0.2% during the first 48 postoperative hours, using a diffuser extensible elastomeric ™ Easypump a volume of 400 mL to 460 mL filled (B Braun) of this solution, a flow rate of 9.53 ml / hour

Locations

Country	Name	City	State
France	Hôpital Civil - NHC Département d'Anesthésiologie	STRASBOURG Cedex	Alsace

Sponsors (1)

Lead Sponsor	Collaborator
University Hospital, Strasbourg, France

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Total intravenous morphine consumption (mg)		the first 48 hours after surgery