University of California, San Diego
To determine whether the addition of erector spinae plane (ESP) catheters to existing multimodal analgesic regimen with intrathecal morphine provides superior postoperative analgesia in patients undergoing hepatic resection compared with patients not receiving ESP catheters.
Hepatic resection surgery is especially painful and requires optimal postoperative pain control for early mobilization and improved respiratory function. While there are many options for pain control, including IV opioids and thoracic epidurals, their utility is often limited by decreased metabolism and coagulopathy respectively. Our institution's current regimen including multimodal analgesia combined with intrathecal morphine and physician discretion with ESP catheters to facilitate postoperative pain management. However, the duration of intrathecal morphine is 24 hours, which is not cover t…
Inclusion Criteria: * undergoing hepatic resection * Admitting service requests APS consult * \>18 years old and able to provide consent Exclusion criteria: * pregnancy * incarceration * inability to communicate with the investigators and hospital staff * severe hepatic disease * chronic high-dose opioid use (defined as daily use for more than 4 weeks prior to surgery of at least the equivalent of 20 mg oxycodone); * BMI \> 40 kg/m2 * allergy to study medications (lidocaine, ropivacaine)
Treatment- continuous erector spinae block catheter followed by an infusion of ropivacaine 0.2% at 10ml automatic set bolus per 60 minute with 2ml/hr continuous infusion (12mls/hr total per catheter)
Placebo- Superficially placed (taped to the surface) erector spinae block catheter with a ropivacaine 0.2% infusion at 0.1ml /hr
200-300 mcg of spinal morphine
Arctuva estimate
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