Efficacy of Perioperative Opioid Sparing Techniques on Time to Initiation of Chemotherapy: A Randomized Single Blinded Control Study
University of Tennessee Graduate School of Medicine
Summary
The primary purpose of this study is to determine if intrathecal morphine (ITM) administration is superior to quadratus lumborum block or surgeon administered transversus abdominis plane (TAP) blocks result in decreased time to initiation of chemotherapy following oncologic surgery. The secondary objectives of this study are to determine: * The difference between interventions in time to return of bowel function in days * The difference between interventions in incidence of opioid related adverse drug events (ORADEs) * The difference between interventions in cumulative and post-operative total morphine milligram equivalents * The difference between interventions in quality-of-life assessment tool and patient satisfaction (brief pain index short form BPI-sf9) * The difference between interventions in hospital length of stay in days * The difference between cumulative pain scores between interventions * The difference between short acting and long-acting bupivacaine in pain management and time to chemotherapy The hypothesis is that preoperative intrathecal morphine administration will significantly reduce the time to initiation of postoperative chemotherapy.
Description
Enhanced recovery after surgery (ERAS) has become the standard of perioperative care for patients undergoing oncologic surgery. Multimodal and regional anesthetic techniques to reduce postoperative pain and opioid requirements are a key component of ERAS. Epidural analgesia was considered standard in early ERAS protocols. however, it is labor-intensive, requires close postoperative follow-up, and may exacerbate hemodynamic instability. Long-acting intrathecal (IT) opioid use in oncologic surgery has been described as an equianalgesic technique to epidural analgesia with an improved safety pro…
Eligibility
- Age range
- 18–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. 18-80 years of age 2. Patients undergoing open surgery for foregut, HPB, and colorectal cancer 3. Able to read and understand study procedures 4. Willing to participate and sign an ICF 5. If female of childbearing potential, subject must have a negative pregnancy test 6. Recommended for adjuvant chemotherapy 7. Patients scheduled for an AM admit procedure 8. English speaking 9. Patients with a midline incision Exclusion Criteria: 1. Chronic Opioid Use (received an opioid within 90 days preoperatively) 2. Recreational Drug Use 3. Patients with cognitive impairments tha…
Interventions
- ProcedureIntrathecal Morphine Block
Morphine 150 mcg
- ProcedureBilateral Quadratus Lumborum Block
30 mL of 0.25% bupivacaine and 4mg of dexamethasone
- ProcedureBilateral Transverse Abdominis Plane Block
Exparel-based solution mixed with 50mL of saline
Location
- University of Tennessee Graduate School of MedicineKnoxville, Tennessee