Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter <i>versus</i> epidural analgesia in open liver resection (LIVER 2 trial)

Hughes, Michael; Harrison, Ewen M; Peel, Natalie; Stutchfield, Ben M.; McNally, Steve; Beattie, C. P.; Wigmore, Stephen J.

doi:10.1002/bjs.9949

Cited by 53 publications

(51 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A longer ROP CWI was preferred in the current study with the aim of improving recovery and reducing the length of hospital stay. CWI is associated with a reduced time to recovery after opened liver resection . Postoperative ileus is a major concern, and enhanced recovery after surgery (ERAS) protocols should be recommended .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A 96‐hour continuous wound infiltration with ropivacaine reduces analgesic consumption after liver resection: A randomized, double‐blind, controlled trial

Peres‐Bachelot

Blanc

Oussaid

et al. 2018

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background: Continuous wound infiltration (CWI) with local anesthetics to reduce morphine consumption in postoperative pain management after open liver resection in patients with cancer.Methods: This single-center randomized double-blind study allocated patients requiring resection of liver metastases to receive a 3.75 mg/mL ropivacaine (ROP) infiltration, followed by a 2 mg/mL ROP CWI, or placebo (P) for 96 hours.Postoperative analgesia included acetaminophen and patient-controlled analgesia morphine pump. The primary endpoint was to investigate the reduction of total morphine consumption (mg/kg) over the first 96 postoperative hours.Results: Eighty-five patients were recruited, and randomized (ROP: 42, P: 43) between 2009 and 2014. The median morphine consumption significantly decreased in the ROP arm in the first 96 postoperative hours (ROP: 1.0, P: 1.5 mg/kg; P = 0.026).Twenty-three (27%) patients had grade 3 adverse events (ROP: 14, P: 9) and four experienced grade 3 treatment-related adverse events (ROP: mental confusion [n = 1], hallucinations [n = 2], P: hematoma [n = 1]). Two (5%) patients showed a wound inflammation (ROP: 1, P: 1). Nine (11%) patients experienced at least one serious adverse event (ROP: 6, P: 3); none related to treatment.Conclusion: Preperitoneal CWI of 2 mg/mL ROP significantly reduces intravenous morphine consumption during the 96 postoperative hours resulting in an absolute reduction of 0.5 mg/kg.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Encouraging results were achieved using CWI in major abdominal surgery and more specifically in open liver surgery, and enhanced recovery outcomes have even been reported. However, results came from series with limited sample sizes …”

Section: Introductionmentioning

confidence: 99%

A 96‐hour continuous wound infiltration with ropivacaine reduces analgesic consumption after liver resection: A randomized, double‐blind, controlled trial

Peres‐Bachelot

Blanc

Oussaid

et al. 2018

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…Other peripheral blocks, such as transversus abdominus plane (TAP) block, could have been placed but the expectation was that such a block would not help the significant visceral pain component expected after exploratory laparotomy. Additionally, it should be noted that there is randomized clinical trial data suggesting that surgical wound infiltration is as effective at pain control as epidural or TAP block interventions [24, 25]. …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as Part of a Multimodal Analgesic Treatment Regimen for Opioid Induced Hyperalgesia in a Patient with Significant Opioid Tolerance

Patch

Eldrige

Moeschler

et al. 2017

Case Reports in Anesthesiology

View full text Add to dashboard Cite

Acute postoperative pain in patients with opioid tolerance creates a significant management challenge for anesthesiologists and pain medicine physicians. A multimodal approach is key; however other factors can complicate management such as opioid induced hyperalgesia. We present the case of a patient on large amounts of intrathecal opioids for chronic pain syndrome with opioid induced hyperalgesia after an exploratory laparotomy. Dexmedetomidine was utilized successfully as part of a controlled multimodal analgesic plan and should be a consideration for opioid tolerant patients experiencing opioid induced hyperalgesia.

show abstract

“…This dosage was chosen because it is also given as a bolus immediately after placement of the catheters. [9] Adherence to the standard operating procedure of this bolus was checked in the operating room (by T.M. ).…”

Section: Methodsmentioning

confidence: 99%

“…A meta-analysis showed comparable pain scores with CWI as compared to epidural analgesia in abdominal surgery. [7] There is also evidence that CWI leads to decreased perioperative hypotension, reduced urinary retention[7] and a fast recovery,[8, 9] although the latter conclusion has been challenged. [10] In a recent randomized controlled trial, we showed CWI to be non-inferior regarding quality of analgesia as well as patient-reported outcomes in patients undergoing hepato-pancreato-biliary surgery.…”

Section: Introductionmentioning

confidence: 99%

Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial

et al. 2017

View full text Add to dashboard Cite

BackgroundContinuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia.MethodsThis was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml.ResultsA total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32).ConclusionsIn this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI.Trial registrationNetherlands Trial Register NTR4948

show abstract

Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial)

Abstract: NCT01747122 ( http://www.clinicaltrials.gov).

Cited by 53 publications

References 34 publications

A 96‐hour continuous wound infiltration with ropivacaine reduces analgesic consumption after liver resection: A randomized, double‐blind, controlled trial

A 96‐hour continuous wound infiltration with ropivacaine reduces analgesic consumption after liver resection: A randomized, double‐blind, controlled trial

Dexmedetomidine as Part of a Multimodal Analgesic Treatment Regimen for Opioid Induced Hyperalgesia in a Patient with Significant Opioid Tolerance

Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial

Contact Info

Product

Resources

About