Efficacy of Multimodal Opioid Therapy During Hepatic Resection Surgery

• Status: Unknown status
• Trial end date: 2008-06-01
• Target enrollment: 0
• Participant gender: All

Summary

The patient population requiring hepatic resection can demonstrate an unpredictable risk of exhibiting peri-operative coagulopathy resulting either from the pre-operative hepatic pathophysiology or volume of parenchymal resection. Choice of analgesia can be severely limited.

Currently, the most commonly described use of combined remifentanil infusion and intrathecal morphine has been in fast-track cardiac surgery. To date, there are no published data describing its use in the context of major hepatobiliary where the investigators predict it may provide adequate analgesia with a lower rate of adverse effects over the first 24 hours after surgery.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: St Vincent's University Hospital, Ireland
• Treatments: Morphine; Remifentanil

Criteria

Inclusion Criteria:

• Adult

• ASA I, II or stable III

• Undergoing primary elective hepatic resection of < 50% predicted parenchymal resection

Exclusion Criteria:

• Previous major upper GI surgery:

• liver resection or transplant

• gastrectomy

• oesophagectomy

• Whipple's procedure

• Contraindications to dural puncture:

• coagulopathy

• uncorrected anti-coagulant therapy

• spinal deformity

• neurological disorder

• psychiatric disorder

• Morphine allergy

• Co-morbidity predisposing to failure of extubation at conclusion of surgery:

• severe cardiopulmonary pathology scoring ASA III (unstable)

• IV

• V

• sleep apnoea

• morbid obesity (BMI > 35)

• Failure to proceed with resection, emergency resection or conversion to > 50% parenchymal resection

• Chronic/intractable pain conditions:

• requiring long-term high dose analgesia

• implanted analgesic devices

• Predisposition to severe post-operative nausea and vomiting:

• motion sickness

• previous PONV

• Anatomical or physiological indication for rapid sequence induction (relative)