Paravertebral Catheters for Pancreatic Surgery

August 30, 2017 updated by: University of Minnesota

Ultrasound Guided Bilateral Paravertebral Catheters Versus Thoracic Epidural Analgesia for Post- Operative Pain Control in Open Pancreatic Surgery: A Prospective Outcomes Study

Design: Level I randomized prospective outcomes study comparing two groups of patients. One group will receive bupivacaine and dilaudid thoracic epidural analgesia (PCA) post-operatively. The other will receive bilateral ultrasound guided paravertebral blocks with indwelling paravertebral catheters with an infusion of 0.2% ropivicaine post-operatively and a PCA.

Sample Size: 50 patients Study Duration: Approximately 12 months Population:. Patients presenting to the University of Minnesota Medical Center for elective open pancreatic surgery.

Primary Objective: To determine if bilateral paravertebral catheters in patients with open pancreatic procedures result in decreased pain compared to patients treated with thoracic epidural for post-operative pain.

Secondary Objectives:

  1. To determine whether the use of bilateral paravertebral catheters impacts the length of ICU and hospital stay for patients, compared to a thoracic epidurals in patients undergoing elective open pancreatic surgery.
  2. To determine whether the use of ultrasound guided bilateral paravertebral catheters leads to lower risk of complications, compared to use of a thoracic epidural in patients undergoing open pancreatic surgery.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Design: Level I randomized prospective outcomes study comparing two groups of patients. One group will receive buipvacanine and dilaudid thoracic epidural analgesia (PCA) post-operatively. The other will receive bilateral ultrasound guided paravertebral blocks with indwelling paravertebral catheters with an infusion of 0.2% ropivicaine post-operatively and a PCA.

Sample Size: 50 patients Study Duration: Approximately 12 months Population:. Patients presenting to the University of Minnesota Medical Center for elective open pancreatic surgery.

Primary Objective: To determine if bilateral paravertebral catheters in patients with open pancreatic procedures result in decreased total maximal pain scores compared to patients treated with thoracic epidural for post-operative pain.

Secondary Objectives:

  1. To determine whether the use of bilateral paravertebral catheters impacts the length of ICU and hospital stay for patients, compared to a thoracic epidurals in patients undergoing elective open pancreatic surgery.
  2. To determine whether the use of ultrasound guided bilateral paravertebral catheters leads to lower risk of complications, compared to use of a thoracic epidural in patients undergoing open pancreatic surgery.

2. Synopsis and Medical Application:

Specific Aims:

Primary Hypothesis: Paravertebral catheters will result in improved pain control relative to thoracic epidural for post-operative pain from open pancreatic surgery.

Secondary Hypothesis: Paravertebral catheters will result in fewer hospital days and improved subjective respiratory function compared to patients in the thoracic epidural group.

Study Type

Interventional

Enrollment (Actual)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Minnesota
      • Minneapolis, Minnesota, United States, 55455
        • University of Minnesota

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 85 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • • All patients undergoing open pancreatic surgery.

Exclusion Criteria:

  • • Previous difficult airway or multiple previous intubations

    • History of myasthenic syndrome
    • Systemic infection
    • Pre-existing sensory deficit
    • PT >14 or PTT >40 sec
    • Platelet count less than 50,000
    • Creatinine > 1.5
    • Allergy to local anesthetics
    • Patients who remain intubated for one week after surgery or who are unable to provide information as to their feelings of pain post-operatively for the first week post-operatively
    • Use of a spinal or epidural anesthetic for surgery
    • Daily use of opioid for more than a week or chronic pain syndrome
    • Lack of patient cooperation
    • Contraindication to regional anesthesia

      • Infection at injection site
      • Inability to guarantee sterile equipment or sterile conditions for the block
      • Patient refusal
      • Risk of local anesthetic toxicity
      • Coagulopathy or bleeding disorder
      • Severe respiratory disease (where the patient depends on intercostal muscle function for ventilation);
      • Ipsilateral diaphragmatic paresis;

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Standard of Care
Epidural placed for postoperative pain control
A mid thoracic epidural is placed preoperatively and a local anesthetic and opioid infusion is run postoperatively
Experimental: Experimental Intervention
Bilateral paravertebral catheters placed for postoperative pain control
Bilateral paravertebral catheters are placed and a local anesthetic infusion via an elastomeric pump is run postoperatively

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
total Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 1 through postoperative day 5
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 1 through postoperative day 5

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 1
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 1
Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 2
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 2
Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 3
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 3
Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 4
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 4
Maximal Pain scored via NRS 0-10 scale
Time Frame: on postoperative day 5
maximal pain scored via NRS 0-10 scale assessed by independent assessor
on postoperative day 5
Nausea/vomiting
Time Frame: the first five days postoperatively
the presence of nausea and or vomiting endorsed by the patient as assessed by an independent assessor
the first five days postoperatively
Length of stay
Time Frame: when the patient meets discharge criteria or is discharged home, expected length of stay 10 days
up through the time the patient is discharged , expected length of stay 10 days.
when the patient meets discharge criteria or is discharged home, expected length of stay 10 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2012

Primary Completion (Actual)

December 1, 2015

Study Completion (Actual)

June 1, 2016

Study Registration Dates

First Submitted

February 3, 2015

First Submitted That Met QC Criteria

February 13, 2015

First Posted (Estimate)

February 16, 2015

Study Record Updates

Last Update Posted (Actual)

August 31, 2017

Last Update Submitted That Met QC Criteria

August 30, 2017

Last Verified

August 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 1203M11482

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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