Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial

Abstract

BackgroundThe current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique.Methods/designThis protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications.DiscussionThis trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015.Trial registrationThe study is registered with http://clinicaltrials.gov ( NCT01960049; 23 September 2013)

Acute and chronic postsurgical pain after living liver donation: Incidence and predictors

“…Our previous retrospective study showing that, in comparison with IV PCA, PCEA provides superior pain relief during the first 3 days after living liver donation supports this suggestion . Currently, our center is evaluating the use of medial open transversus abdominis plane catheters to better manage pain after open liver resection as an alternative to PCEA and IV PCA (Karanicolas et al) …”

“…23 Currently, our center is evaluating the use of medial open transversus abdominis plane catheters to better manage pain after open liver resection as an alternative to PCEA and IV PCA (Karanicolas et al). 62 Understanding and improving pain outcomes among living liver donors has been identified as a key priority by liver transplant clinicians and researchers and is a current focus of the National Institutes of Healthfunded Adult-to-Adult Living Donor Liver Transplantation Cohort Study. 1,23,63,64 The use of a prospective design in the present study allowed for unique insights into pain outcomes, and it suggests that there continues to be room for improvement in the management of pain after donor hepatectomy.…”

In‐hospital opioid consumption, but not pain intensity scores, predicts 6‐month levels of pain catastrophizing following hepatic resection: A trajectory analysis

“…Please refer to published study protocol for details (Karanicolas et al., ). The Research Ethics Boards from Sunnybrook Health Sciences Centre (178‐2013) and University Health Network (12‐0493‐A) approved this registered trial (http://clinicaltrials.gov NCT01960049, Sept 23, 2013).…”

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

“…Further investigation is needed in order to draw more meaningful conclusions. To that end, different routes of delivery for local anesthestics (beyond PO, neuraxial, and IV), such as medial open transversus abdominis plane (MOTAP) catheters which deliver local anesthetic into the abdominal cavity to anesthetize the neural plexus supplying the anterior abdominal wall cephalad to the umbilicus (dermatomes T6-10), are currently being investigated in the perioperative setting following liver resection and other major surgical interventions to study secondary effects such as the development of CPSP [65]. To date, the available literature suggests that local anesthetics as a class are equivocal to placebo for CPSP.…”

“…Multimodal pain regimens that include gabapentin, NSAIDs, acetaminophen, and regional anesthesia were effective in controlling perioperative pain and decreasing perioperative opioid use following arthroplasty surgery [74,75]. The literature has highlighted the need for studies focused on multimodal analgesic protocols for colorectal [76], thoracic, amputation, mastectomy [77], orthopaedic [37], and liver resection surgeries [65]. In these trials, the outcome of interest should not only focus on reducing acute postoperative pain and opioid consumption (due to the immediate drug effect), but also on ascertaining whether preventive effects that reduce the incidence and severity of CPSP are demonstrated.…”